title: Emergency department lengths of stay: characteristics favouring a delay to the admission decision as distinct from a delay while awaiting an inpatient bed.
abstract: BACKGROUND
  A prolonged stay for a patient within the emergency department (ED) can adversely affect the outcome of their ensuing hospital admission.
  
  
  OBJECTIVE
  To investigate the characteristics of those eventual general medical hospital inpatients who stay in the ED awaiting a decision to be admitted and then await a bed.
  
  
  METHODS
  Data from Flinders Medical Centre's patient journey database were analysed. The analysis was carried out on 19 476 patients admitted as an emergency under the General Medicine units.
  
  
  RESULTS
  A less urgent Australian Triage Scale category significantly prolonged triage-to-admit time but did not affect boarding time. The decision to admit a patient took 29% longer for patients who presented to the ED outside of working hours. However, a decision to admit taken outside working hours meant the boarding time was over 3 h shorter than if the decision had been taken inside working hours. For every additional patient in the ED at the time of presentation, the admission decision was delayed by about half a minute. Every additional patient in the ED at the time of an admission decision increased boarding time by almost 10 min.
  
  
  CONCLUSIONS
  Outside of working hours, patients presenting to ED have longer triage-to-admit times while patients for admission have shorter boarding times. ED congestion delays admission decisions only slightly and prolongs patients' boarding times to a greater extent. Strategies to reduce the time patients spend in ED should differ depending on whether a decision to admit the patient has been reached.
authors.affiliation: School of Computer Science, Engineering and Mathematics, Flinders University, Adelaide, South Australia, Australia.
authors.forename: L
authors.initials: L
authors.lastname: Perimal-Lewis
authors.forename: D I
authors.initials: DI
authors.lastname: Ben-Tovim
authors.forename: J Y
authors.initials: JY
authors.lastname: Li
authors.forename: P H
authors.initials: PH
authors.lastname: Hakendorf
authors.forename: C H
authors.initials: CH
authors.lastname: Thompson
mesh_terms: D000328:Adult; D016638:Critical Illness / Q000628:therapy*; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006769:Hospitals, General; D006801:Humans; D007297:Inpatients; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D010343:Patient Admission / Q000639:trends*; D012189:Retrospective Studies; D013021:South Australia; D013997:Time Factors; D014218:Triage / Q000379:methods*
keywords: admitting department hospital; capacity building; emergency service hospital; healthcare delivery; public hospital