title: Patient and organizational characteristics predict a long length of stay in the emergency department - a Swedish cohort study.
abstract: BACKGROUND
  Emergency departments (EDs) constitute a central part of the healthcare system that receives patients with complaints of varied urgency. A long length of stay (LOS) in the ED is associated with crowding, low patient satisfaction and poor patient outcomes. Therefore, it is important to understand the key drivers and patient characteristics associated with long LOS.
  
  
  OBJECTIVE
  To identify patient-related and organization-related characteristics associated with the longest ED LOS.
  
  
  METHODS
  All adult visits (n=19 503) to the ED at Karolinska University Hospital in Solna, Sweden, between 8 a.m. and 9 p.m. during 2012 were divided into quartiles on the basis of their LOS. The quartile with the longest LOS (n=4876) was compared with the two intermediate quartiles (n=9752) and the shortest quartile (n=4875). Differences in patient and organizational characteristics were assessed using multivariate logistic regression models to achieve odds ratios (ORs) with 95% confidence intervals (CIs).
  
  
  RESULTS
  The patient-related factors associated with long LOS were female sex (OR 1.22, 95% CI 1.14-1.30), age 65-79 (OR 1.82, 95% CI 1.67-1.97), age 80 or older (OR 2.76, 95% CI 2.52-3.02) and the chief complaint of dyspnoea (OR 1.55, 95% CI 1.39-1.73).
  
  
  CONCLUSIONS
  Long LOS in the ED is associated with both patient and organizational characteristics and the elderly are at particular risk of long LOS. These insights may be used to improve patient outcome metrics and enhance ED efficiency. Further studies are needed to clarify the role of additional factors as well as the causality of the studied factors.
authors.affiliation: aEmergency Department, Karolinska University Hospital Solna bDepartment of Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Tobias
authors.initials: T
authors.lastname: Perdahl
authors.forename: Sandra
authors.initials: S
authors.lastname: Axelsson
authors.forename: Per
authors.initials: P
authors.lastname: Svensson
authors.forename: Therese
authors.initials: T
authors.lastname: Djärv
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004417:Dyspnea / Q000453:epidemiology / Q000628:therapy; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012737:Sex Factors; D013548:Sweden; D055815:Young Adult