title: Prolonged Emergency Department Length of Stay as a Predictor of Adverse Outcomes in Patients with Intracranial Hemorrhage.
abstract: OBJECTIVE
  Extended time in the emergency department (ED) has been related to adverse outcomes among stroke patients. We examined the associations of ED nursing shift change (SC) and length of stay in the ED with outcomes in patients with intracerebral hemorrhage (ICH).
  
  
  METHODS
  Data were collected on all spontaneous ICH patients admitted to our stroke center from 7/1/08-6/30/12. Outcomes (frequency of pneumonia, modified Rankin Scale (mRS) score at discharge, NIHSS score at discharge, and mortality rate) were compared based on shift change experience and length of stay (LOS) dichotomized at 5 hours after arrival.
  
  
  RESULTS
  Of the 162 patients included, 60 (37.0%) were present in the ED during a SC. The frequency of pneumonia was similar in the two groups. Exposure to an ED SC was not a significant independent predictor of any outcome. LOS in the ED ≥5 hours was a significant independent predictor of discharge mRS 4-6 (OR 3.638, 95% CI 1.531-8.645, andP= 0.0034) and discharge NIHSS (OR 3.049, 95% CI 1.491-6.236, andP= 0.0023) but not death.
  
  
  CONCLUSIONS
  Our study found no association between nursing SC and adverse outcome in patients with ICH but confirms the prior finding of worsened outcome after prolonged length of stay in the ED.
authors.affiliation: Comprehensive Stroke Center, Department of Neurology, Tulane University, New Orleans, LA, USA.
authors.forename: Erica M
authors.initials: EM
authors.lastname: Jones
authors.affiliation: Department of Neurology, Columbia University, New York, NY, USA.
authors.forename: Amelia K
authors.initials: AK
authors.lastname: Boehme
authors.affiliation: Comprehensive Stroke Center, Department of Neurology, Tulane University, New Orleans, LA, USA.
authors.forename: Aimee
authors.initials: A
authors.lastname: Aysenne
authors.affiliation: Departments of Neurosurgery and Neurology, University of Texas Medical School at Houston, USA.
authors.forename: Tiffany
authors.initials: T
authors.lastname: Chang
authors.affiliation: Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Karen C
authors.initials: KC
authors.lastname: Albright
authors.affiliation: Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Burns
authors.affiliation: Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: T Mark
authors.initials: TM
authors.lastname: Beasley
authors.affiliation: Comprehensive Stroke Center, Department of Neurology, Tulane University, New Orleans, LA, USA.
authors.forename: Sheryl
authors.initials: S
authors.lastname: Martin-Schild