title: Predictive factors for longer length of stay in an emergency department: a prospective multicentre study evaluating the impact of age, patient's clinical acuity and complexity, and care pathways.
abstract: BACKGROUND
  It has been reported that emergency department length of stay (ED-LOS) for older patients is longer than average. Our objective was to determine the effect of age, patient's clinical acuity and complexity, and care pathways on ED-LOS and ED plus observation unit (EDOU) LOS (EDOU-LOS).
  
  
  METHODS
  This was a prospective, multicentre, observational study including all patients attending in 2011. Age groups were: I, <50; II, ≥50-64; III, ≥65-74; IV, ≥75-84; V, ≥85 years. Univariate and multivariate analyses were performed.
  
  
  RESULTS
  Of 125 478 attendances, 20 845(16.6%) were of patients aged ≥65 years. Multivariate analysis found significant predictors for ED-LOS (C-statistics 0.79, p<0.0000001) to be: arrival mode (ambulance, OR 1.13 (95% CI 1.08 to 1.18)); acuity level (level 4, OR 1.24 (95% CI 1.21 to 1.28); level 1-3, OR 1.54 (95% CI 1.5 to 1.59)); haematological examinations (OR 3.34 (95% CI 3.15 to 3.56)); intravenous treatment (OR 1.58 (95% CI 1.47 to 1.69)); monitoring of vital signs (OR 1.89 (95% CI 1.69 to 2.10)); x-ray examinations (OR 1.53 (95% CI 1.45 to 1.61)); CT/MRI/ultrasound (OR 2.60 (95% CI 2.39 to 2.82)); and specialist advice (OR 1.39 (95% CI 1.30 to 1.48)). For EDOU-LOS (C-statistics 0.81, p<0.0000001) we found: age group (II, OR 1.19 (95% CI 1.16 to 1.22); III, OR 1.42 (95% CI 1.38 to 1.46); IV, OR 1.69 (95% CI 1.65 to 1.74); V, 2.01 (95% CI 1.96 to 2.07)); acuity level (level 4, OR 1.31 (95% CI 1.27 to 1.35); level 1-3, OR 1.71 (95% CI 1.66 to 1.77)); haematological examinations (OR 7.81 (95% CI 7.23 to 8.43)); intravenous treatment (OR 1.95 (95% CI 1.8 to 2.12)); x-ray examinations (OR 1.95 (95% CI 1.85 to 2.06)); CT/MRI/ultrasound (OR 6.74 (95% CI 5.98 to 7.6)); specialist advice (OR 2.24 (95% CI 2.07 to 2.42)); admission to a medical or surgical ward (OR 0.61 (95% CI 0.54 to 0.68)); and transfer (OR 1.79 (95% CI 1.54 to 2.07)).
  
  
  CONCLUSIONS
  Whereas ED-LOS and EDOU-LOS seem to be directly related to patients' acuity and complexity, notably the need for diagnostic and therapeutic interventions, only EDOU-LOS was significantly associated with age and proposed care pathways. We propose that EDOU-LOS measurement should be made in EDs with an OU.
authors: Enrique
authors: E
authors: Casalino
authors: Mathias
authors: M
authors: Wargon
authors: Emergency Department, Assistance Publique-Hôpitaux de Paris (AP-HP), University Hospital Bichat-Claude Bernard, Paris, France Medical Information Systems Program (PMSI), University Hospital Bichat-Claude Bernard, Paris, France.
authors: Anne
authors: A
authors: Peroziello
authors: Emergency Department, Assistance Publique-Hôpitaux de Paris (AP-HP), University Hospital Bichat-Claude Bernard, Paris, France Study Group for Efficiency and Quality of Emergency Departments and Non-Scheduled Activities Departments, Paris, France.
authors: Christophe
authors: C
authors: Choquet
authors: Emergency Department, Assistance Publique-Hôpitaux de Paris (AP-HP), University Hospital Louis Mourier, Paris, France.
authors: Christophe
authors: C
authors: Leroy
authors: Emergency Department, Assistance Publique-Hôpitaux de Paris (AP-HP), University Hospital Beaujon, Paris, France.
authors: Sebastien
authors: S
authors: Beaune
authors: Laurent
authors: L
authors: Pereira
authors: Julien
authors: J
authors: Bernard
authors: Medical Information Systems Program (PMSI), University Hospital Bichat-Claude Bernard, Paris, France.
authors: Jean-Claude
authors: JC
authors: Buzzi
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D019091:Critical Pathways; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D062072:Patient Acuity; D011446:Prospective Studies; D012307:Risk Factors; D055815:Young Adult
keywords: Clinical Care; Clinical Management; Emergency Department Management