B. Steren2, M. Fleming1, H. Zhuo3, Y. Zhang3, K. Pei1,4 1Yale University School Of Medicine,Department Of Surgery,New Haven, CT, USA 2Yale University School Of Medicine,New Haven, CT, USA 3Yale University School Of Medicine,Section Of Surgical Outcomes And Epidemiology,New Haven, CT, USA 4Texas Tech University of Health Sciences Center, School of Medicine,Department Of Surgery,Lubbock, TX, USA
Introduction: Delayed emergency department (ED) throughput has been associated with increased mortality and increased length of stay (LOS) for various patient populations. Trauma patients often require significant effort in evaluation, work up, and disposition; however, patient and hospital characteristics associated with increased LOS in the ED remain unclear.
Methods: The Trauma Quality Improvement Project database (2014-2016) was queried for all adult blunt trauma patients. Patients discharged from the ED to the operating room were excluded. Univariate and multivariable linear regression analysis was conducted to identify independent predictors of prolonged ED length of stay, controlling for patient characteristics (age, gender, race, insurance status), hospital characteristics (teaching status, ACS level, geographic region) and injury severity score and abbreviated injury severity score (ISS and AIS).
Results: 412,000 patients met inclusion criteria for analysis. When controlling for covariates, an increase in age by 1 year resulted in 0.78 increased minutes in the ED (p<0.0001). On multivariable linear regression controlling for injury severity and comorbid conditions, non-white race groups, university status and northeast region were associated with increased ED dwell time. Black and Hispanic patients spent on average 41.76 and 40.06 more minutes respectively in the ED room when compared to white patients (p <.0001). Patients seen at University hospitals spent 52.50 more minutes in the ED when compared to community hospitals whereas patients at non-teaching hospitals spent 32.32 fewer minutes (p <.0001). Patients seen in the Midwest spent the least amount of time in the ED, with patients in the South, West, and Northeast spending 44.87, 36.02 and 89.41 more minutes respectively (p <.0001). Non-Medicaid patients at Level 1 trauma centers and those requiring intensive care admission had significantly decreased ED dwell time. Medicaid patients took the longest to move through the ED with Medicare, BlueCross and Private insurance outpacing them by 17.69, 26.67 and 27.11 minutes respectively (p <.0001). Level 1 trauma centers moved patients through the ED fastest, with level II centers experiencing 49.56-minute delays and level III centers experiencing 130.34-minute delays (p <.0001). Not surprisingly, patients admitted to the ICU spent the least amount of time in the ED when compared to those admitted to floor or other (p <.0001).
Conclusion: ED length of stay varied significantly by patient and hospital characteristics. Medicaid patients and university status were associated with significantly higher ED dwell time, while ACS level verification status had strong correlation with ED throughput. These results may allow targeted quality improvement programs to enhance ED throughput.