title: Length of stay in EDs: variation across classifications of clinical condition and patient discharge disposition.
abstract: OBJECTIVE
  Duration of a stay in an emergency department (ED) is considered a measure of quality, but current measures average lengths of stay across all conditions. Previous research on ED length of stay has been limited to a single condition or a few hospitals. We use a census of one state's data to measure length of ED stays by patients' conditions and dispositions and explore differences between means and medians as quality metrics.
  
  
  METHODS
  The data source was the Healthcare Cost and Utilization Project 2011 State Emergency Department Databases and State Inpatient Databases for Florida. Florida is unique in collecting ED length of stay for both released and admitted patients. Clinical Classifications Software was used to group visits based on first-listed International Classification of Disease, Ninth Edition, Clinical Modification, diagnoses.
  
  
  RESULTS
  For the 10 most common diagnoses, patients with relatively minor injuries typically required the shortest mean stay (3 hours or less); conditions resulting in admission or transfer tended to be more serious, resulting in longer stays. Patients requiring the longest stays, by disposition, had discharge diagnoses of nonspecific chest pain (mean 7.4 hours among discharged patients), urinary tract infections (4.8 hours among admissions), and schizophrenia (9.6 hours among transfers) among the top 10 diagnoses.
  
  
  CONCLUSIONS
  Emergency department length of stay as a measure of ED quality should take into account the considerable variation by condition and disposition of the patient. Emergency department length of stay measurement could be improved in the United States by standardizing its definition; distinguishing visits involving treatment, observation, and boarding; and incorporating more distributional information.
authors.affiliation: Agency for Healthcare Research and Quality, Center for Quality Improvement and Patient Safety, Rockville, MD, USA.
authors.forename: Ernest
authors.initials: E
authors.lastname: Moy
authors.affiliation: Truven Health Analytics, Bethesda, MD, USA.
authors.forename: Rosanna M
authors.initials: RM
authors.lastname: Coffey
authors.affiliation: Truven Health Analytics, Ann Arbor, MI, USA. Electronic address: brian.moore@truvenhealth.com.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Moore
authors.affiliation: M.L. Barrett, Inc, Del Mar, CA, USA.
authors.forename: Marguerite L
authors.initials: ML
authors.lastname: Barrett
authors.affiliation: MedStar Health, Washington, DC, USA.
authors.forename: Kendall K
authors.initials: KK
authors.lastname: Hall
mesh_terms: D000367:Age Factors; D016208:Databases, Factual; D004636:Emergency Service, Hospital / Q000592:standards*; D005431:Florida; D006801:Humans; D038801:International Classification of Diseases; D007902:Length of Stay; D010343:Patient Admission; D010351:Patient Discharge; D010360:Patient Transfer; D011787:Quality of Health Care; D012189:Retrospective Studies; D013997:Time Factors