title: Why do general medical patients have a lengthy wait in the emergency department before admission?
abstract: OBJECTIVE
  Emergency department (ED) overcrowding is a universal problem, especially with the shortage of hospital beds. We studied the characteristics and outcomes of patients with prolonged ED stays, which has rarely been studied before.
  
  
  METHODS
  We conducted a retrospective study at a tertiary medical center in Taiwan. Prolonged stay in the ED was defined as a stay of more than 72 hours in the ED before admission. The medical records were reviewed for data analysis.
  
  
  RESULTS
  From November 1, 2009 to January 31, 2010, a total of 1364 general medical patients were enrolled. The mean age was 66.4 ± 17.8 years, with 53.4% male. The mean Charlson Comorbidity Index (CCI) was 3.0 ± 3.1. The mean length of ED stay was 43.9 ± 41.0 hours. The CCI (4.1 ± 3.5 vs. 2.8 ± 3.0, p < 0.001) and do-not-resuscitate (DNR) rates (18.8% vs. 10.3%, p = 0.001) of the patients with prolonged ED stays were higher than those of the patients with shorter stays. For patients with high CCI (≥3) and DNR consent, the odds ratio of prolonged ED stay was 1.73 and 1.60, respectively. Patients with prolonged ED stays also had a lower Barthel index (60.3 ± 34.8 vs. 66.4, p = 0.011) and higher in-hospital mortality (11.6% vs. 6.0%, p = 0.006).
  
  
  CONCLUSIONS
  Complex comorbidities and terminal conditions with DNR consent were associated with the prolonged ED stay for general medical patients. The hospital manager should pay attention to general medical patients with multiple comorbidities as well as those who require palliative care.
authors.affiliation: Division of Hospital Medicine, Department of Traumatology, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Institute of Health Policy and Management, College of Public Health, National Taiwan University, No. 17, Xu-Zhou Road, Taipei, Taiwan.
authors.forename: Nin-Chieh
authors.initials: NC
authors.lastname: Hsu
authors.affiliation: Division of Hospital Medicine, Department of Traumatology, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Chin-Chung
authors.initials: CC
authors.lastname: Shu
authors.affiliation: Division of Hospital Medicine, Department of Traumatology, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Yu-Feng
authors.initials: YF
authors.lastname: Lin
authors.affiliation: Institute of Health Policy and Management, College of Public Health, National Taiwan University, No. 17, Xu-Zhou Road, Taipei, Taiwan. Electronic address: mcyang637@ntu.edu.tw.
authors.forename: Ming-Chin
authors.initials: MC
authors.lastname: Yang
authors.affiliation: Institute of Health Policy and Management, College of Public Health, National Taiwan University, No. 17, Xu-Zhou Road, Taipei, Taiwan.
authors.forename: Syi
authors.initials: S
authors.lastname: Su
authors.affiliation: Division of Hospital Medicine, Department of Traumatology, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Wen-Je
authors.initials: WJ
authors.lastname: Ko
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010343:Patient Admission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013624:Taiwan; D062606:Tertiary Care Centers; D061665:Time-to-Treatment
keywords: Barthel index; Charlson comorbidity index; do-not-resuscitate consent; emergency department stay