(withdrawn)The Effect Of Emergency Department Length Of Stay On Clinical Outcomes For Critically Ill Or Injured Patients

Purpose:
Quality improvement data at a large regional referral hospital revealed problems with ED through-put and extended ED stay. The purpose of this study was to identify the effects of emergency department length of stay on clinical outcomes for critically ill or injured patients.

Background/Significance:
Visits to the emergency department continue to increase due to changes in healthcare coverage and primary care access. The CDC reported 123 million persons visited the emergency department in 2008, resulting in an increased volume of up to 20%. Approximately 2 million of these patients were admitted to critical care. Critical care patients often have extended stays in the emergency department, often resulting in increased mortality, prolonged hospital stay, and other adverse outcomes.

Methods:
A quantitative, descriptive, retrospective design was used. The study was conducted in a regional referral hospital in southeastern United States. Data were collected from APACHE II database, trauma registry, and ED logs. The sample included 1520 patients admitted to a critical care unit from the ED. Variables of interest included age, race and gender, day of week, time of arrival to ED, time to the ICU, LOS for ICU, overall hospital LOS, and outcome data to include VAP, CLABSI, and mortality. Data analysis included descriptive statistics and correlation.

Results:
Critically ill or injured patients who stayed in the ED greater than 3 hours and less than 6 hours were more likely to die in the critical care unit (n = 46, p = 0.033). During the study period, fourteen patients developed ventilator associated pneumonia. Five of the fourteen patients were intubated in the emergency department and developed a ventilator associated pneumonia (p = 0.042).

Conclusions and Implications for Practice:
Results suggest significant effects on mortality with transfer delays of 3-6 hours, to include an increased rate of ventilator associated pneumonia. As emergency departments continue to function at or over capacity, further exploration of specific factors affecting patient outcomes is recommended.