S. Lane1, J. Nahmias1, M. Lekawa1, J. C. Fox1, C. Chandwani1, S. Lotfipour1, A. Grigorian1 1University Of California – Irvine, Department Of Surgery, Division Of Trauma, Burns And Surgical Critical Care, Orange, CA, USA
Introduction: The efficient utilization of resources is a crucial aspect of healthcare, particularly in both Level-I and Level-II American College of Surgeons (ACS) verified trauma centers. The effect of resource allocation on Emergency Department length of stay (ED-LOS) of trauma patients has remained under-investigated. As ED overcrowding has become more prevalent and amplified by the escalation of respiratory diseases, especially at quaternary care centers, an evaluation of the potential disparities in ED-LOS between Level-I and Level-II centers is warranted. We hypothesize a longer ED-LOS at Level-I centers compared to Level-II centers.
Methods: We queried the 2017-2021 Trauma Quality Improvement Process (TQIP) database for trauma patients >18-years old presenting to either a Level-I or II center. TQIP defines ED-LOS by the time the order was written for the patient to be discharged from the ED and includes the time from arrival to disposition from the ED (admission or discharge). We excluded transferred patients or those with missing data regarding ACS center verification level. Bivariate analyses were performed.
Results: From 2,225,067 trauma patients, 59.3% (1,318,497) received treatment at Level-I centers. No significant differences were found in injury severity scores between patients admitted to the operating room, non-intensive care unit (ICU) locations, or discharged from Level-I and Level-II centers (all p>0.05). However, the ED-LOS for trauma patients was notably longer at Level-I centers for all patient categories: overall (198 vs. 145 minutes, p<0.001), discharged home (286 vs. 160 minutes, p<0.001), non-ICU admissions (234 vs 164 minutes, p<0.001), or those requiring surgery (126 vs. 101, p<0.001).
Conclusion: Even when treating patients with similar injury severity, trauma patients at Level-I centers had longer ED-LOS compared to Level-II centers, irrespective of the patients' final disposition (surgery, non-ICU admission, or discharge). To optimize resource utilization and alleviate ED saturation, further research must delve into the underlying causes of these discrepancies and help identify best practices and solutions.
