Organisational Factors Induce Prolonged Emergency Department Length of Stay in Elderly Patients--A Retrospective Cohort Study.
OBJECTIVE
To assess the association of patient and organisational factors with emergency department length of stay (ED-LOS) in elderly ED patients (226565 years old) and in younger patients (<65 years old).


METHODS
A retrospective cohort study of internal medicine patients visiting the emergency department between September 1st 2010 and August 31st 2011 was performed. All emergency department visits by internal medicine patients 226565 years old and a random sample of internal medicine patients <65 years old were included. Organisational factors were defined as non-medical factors. ED-LOS is defined as the time between ED arrival and ED discharge or admission. Prolonged ED-LOS is defined as ≥75th percentile of ED-LOS in the study population, which was 208 minutes.


RESULTS
Data on 1782 emergency department visits by elderly patients and 597 emergency department visits by younger patients were analysed. Prolonged ED-LOS in elderly patients was associated with three organisational factors: >1 consultation during the emergency department visit (odds ratio (OR) 3.2, 95% confidence interval (CI) 2.3-4.3), a higher number of diagnostic tests (OR 1.2, 95% CI 1.16-1.33) and evaluation by a medical student or non-trainee resident compared with a medical specialist (OR 4.2, 95% CI 2.0-8.8 and OR 2.3, 95% CI 1.4-3.9). In younger patients, prolonged ED-LOS was associated with >1 consultation (OR 2.6, 95% CI 1.4-4.6). Factors associated with shorter ED-LOS were arrival during nights or weekends as well as a high urgency level in elderly patients and self-referral in younger patients.


CONCLUSIONS
Organisational factors, such as a higher number of consultations and tests in the emergency department and a lower seniority of the physician, were the main aspects associated with prolonged ED-LOS in elderly patients. Optimisation of the organisation and coordination of emergency care is important to accommodate the needs of the continuously growing number of elderly patients in a better way.
Department of Internal Medicine, Máxima Medical Centre, Eindhoven/Veldhoven, the Netherlands.
Steffie H A
SH
Brouns
Department of Internal Medicine, division of general medicine, section acute medicine, Maastricht University Medical Centre, Maastricht, the Netherlands.
Patricia M
PM
Stassen
Department of Internal Medicine, Máxima Medical Centre, Eindhoven/Veldhoven, the Netherlands.
Suze L E
SL
Lambooij
Máxima Medical Centre Academy, Máxima Medical Centre, Eindhoven/Veldhoven, the Netherlands.
Jeanne
J
Dieleman
School of Industrial Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.
Irene T P
IT
Vanderfeesten
Department of Internal Medicine, Máxima Medical Centre, Eindhoven/Veldhoven, the Netherlands; Department of Internal Medicine, division of general medicine, section acute medicine, Maastricht University Medical Centre, Maastricht, the Netherlands; Maastricht University, Department of Health Services Research and CAPHRI School for Public Health and Primary Care, Maastricht, the Netherlands.
Harm R
HR
Haak
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D004632:Emergency Medical Services; D004636:Emergency Service, Hospital; D006801:Humans; D007902:Length of Stay; D008875:Middle Aged; D010343:Patient Admission; D012307:Risk Factors