title: Increased door to admission time is associated with prolonged throughput for ED patients discharged home.
abstract: BACKGROUND
  Emergency Department (ED) service evaluations are typically based on surveys of discharged patients. Physicians/administrators benefit from data that quantifies system-based factors that adversely impact the experience of those who represent the survey cohort.
  
  
  OBJECTIVE
  While investigators have established that admitted patient boarding impacts overall ED throughput times, we sought to specifically quantify the relationship between throughput times for patients admitted (EDLOS) versus discharged home from the ED (DCLOS).
  
  
  METHODS
  We performed a prospective analysis of consecutive patient encounters at an inner-city ED. Variables collected: median daily DCLOS for ED patients, ED daily census, left without being seen (LWBS), median door to doctor, median room to doctor, and daily number admitted. Admitted patients divided into 2 groups based on daily median EDLOS for admits (<6 hours, ≥6 hours). Continuous variables analyzed by t-tests. Multivariate regression utilized to identify independent effects of the co-variants on median daily DCLOS.
  
  
  RESULTS
  We analyzed 24,127 patient visits. ED patient DCLOS was longer for patients seen on days with prolonged EDLOS (193.7 minutes, 95%CI 186.7-200.7 vs. 152.8, 144.9-160.5, P< .0001). Variables that were associated with increased daily median EDLOS for admits included: daily admits (P= 0.01), room to doctor time (P< .01), number of patients that left without being seen (P< .01). When controlling for the covariate daily census, differences in DCLOS remained significant for the ≥6 hours group (189.4 minutes, 95%CI 184.1-194.7 vs. 164.8, 155.7-173.9 (P< .0001).
  
  
  CONCLUSIONS
  Prolonged ED stays for admitted patients were associated with prolonged throughput times for patients discharged home from the ED.
authors.affiliation: Department of Emergency Medicine, Texas A&M Health Science Center/Christus Spohn, Corpus Christi, TX.
authors.forename: Scott P
authors.initials: SP
authors.lastname: Krall
authors.affiliation: Department of Mathematics, Texas A&M University-Corpus Christi, Corpus Christi, TX.
authors.forename: Jose
authors.initials: J
authors.lastname: Guardiola
authors.affiliation: Department of Emergency Medicine, Texas A&M Health Science Center/Christus Spohn, Corpus Christi, TX. Electronic address: PRichmanMDMBA@gmail.com.
authors.forename: Peter B
authors.initials: PB
authors.lastname: Richman
mesh_terms: D000328:Adult; D002648:Child; D015331:Cohort Studies; D004636:Emergency Service, Hospital; D005260:Female; D006760:Hospitalization; D006786:Hospitals, Urban; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D015999:Multivariate Analysis; D010343:Patient Admission; D010351:Patient Discharge; D011446:Prospective Studies; D012044:Regression Analysis; D013997:Time Factors