title: Factors associated with the length of stay of patients discharged from emergency department in France.
abstract: OBJECTIVE
  The length of stay in the emergency department (ED) has been proposed as an indicator of performance in many countries. We conducted a survey of length of stay in two large areas in France and tested the hypothesis that patient and ED-related variables may influence it.
  
  
  METHODS
  During 2007, we examined lengths of stay in ambulatory patients, that is, excluding admitted patients. The following variables were considered: (a) at the patient level, age, sex, the day and month of the visit, and the French clinical classification of emergency patients (CCEP) class; (b) at the ED level, annual ED total number of visits, mean age, the proportions of patients less than 15 and more than 75 years, and the proportions of admitted and clinically stable patients with CCEP class 1 and 2. A multilevel hierarchical analysis was carried out.
  
  
  RESULTS
  We analyzed 988 591 visits in 53 EDs. The ED-specific median length of stay was 98 (IQR: 62-137) min and the ED-specific median proportion of patients with length of stay of more than 4 h was 15 (5-24) %. There was a strong correlation between the ED-specific median length of stay and the ED-specific proportion of patients with a length of stay of more than 4 h (R=0.96, P<0.001). Using a multilevel analysis, only three variables were associated significantly with the length of stay: the age and the CCEP class of the patient, and the ED census.
  
  
  CONCLUSIONS
  We observed that the length of stay in the ED needs to be stratified by case mix and the total number of visits of the ED.
authors.affiliation: aManagement in Health Services Research Department, Ecole des Hautes Etudes en Santé Publique (EHESP), Institut Gustave Roussy, Villejuif bObservatoire des Urgences Midi-Pyrénées (ORU-MiP), Toulouse cMedical Headquarter, Assistance-Publique Hôpitaux de Paris (APHP) dEmergency Department, Centre Hospitalo-Universitaire (CHU) Saint Antoine, APHP, Université Pierre et Marie Curie (UPMC), Paris eEmergency Department, CHU Pitié-Salpêtrière, APHP, UPMC, Paris fPrehospital Emergency Department, SAMU 38, CHU de Grenoble, Grenoble gPrehospital Emergency Department, SAMU 95, Hôpital de Pontoise, Pontoise, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Capuano
authors.forename: Anne-Sophie
authors.initials: AS
authors.lastname: Lot
authors.forename: Christine
authors.initials: C
authors.lastname: Sagnes-Raffy
authors.forename: Marie
authors.initials: M
authors.lastname: Ferrua
authors.forename: Dominique
authors.initials: D
authors.lastname: Brun-Ney
authors.forename: Henri
authors.initials: H
authors.lastname: Leleu
authors.forename: Dominique
authors.initials: D
authors.lastname: Pateron
authors.forename: Guillaume
authors.initials: G
authors.lastname: Debaty
authors.forename: Marc
authors.initials: M
authors.lastname: Giroud
authors.forename: Etienne
authors.initials: E
authors.lastname: Minvielle
authors.forename: Bruno
authors.initials: B
authors.lastname: Riou
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004638:Emergency Treatment / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D005602:France; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data*; D063868:Patient Outcome Assessment; D018570:Risk Assessment; D012737:Sex Factors; D055815:Young Adult