Duration of Patients' Visits to the Hospital Emergency Department

Zeynal Karaca; Herbert S Wong; Ryan L Mutter

Disclosures

BMC Emerg Med. 2012;12(15) 

In This Article

Conclusions

Our results show that the mean duration for a T&R ED visit was slightly above 3 hours and it varied considerably by admission hour and day of the week, patient volume, patient characteristics, hospital characteristics and area characteristics. When documenting the mean duration, we uncovered a significant spike in mean duration of ED visits at around midnight, occurring mostly on Monday nights at for-profit hospitals. Based on patient demographics and hospital characteristics, we identified several important factors that are associated with increased ED stays. We identified a direct relationship between increased duration of T&R ED visits and patient age, race, gender, and severity of illness; and hospital ownership type and location. Elderly patients, patients with mental disorders or neoplasm, non-white patients, and female patients experienced longer ED stays than did other patients. Consistent with existing literature, our results suggest that, in the aggregate, lack of health insurance did not have a significant direct association with longer mean duration of ED visits. The mean duration of ED visits was substantially longer at non-profit hospitals when compared to for-profit hospitals, and at Level 1 trauma centers when compared to other trauma centers or non-trauma centers. We also show that the mean duration of ED visits for patients discharged to home health care or other long term care facilities was substantially higher when compared to patients discharged home or elsewhere. Our findings may also inform public and private policymakers on a broad range of issues including, but not limited to, Monday volume, impact of hospital bed size and hospital status on the mean duration of T&R ED visits, and differences in duration by race.

Some of the results are consistent with the literature's characterization of care provided in the ED and are expected. Level I trauma centers, for example, have comprehensive resources and are able to care for the most severely injured patients. They also provide leadership in education and research. Therefore, it is not surprising that they have the longest duration for T&R patients. Other findings are not as easy to interpret. We found earlier that a larger share of patients transferred to short-term hospitals or other facilities could be one of the contributing factors for longer duration of visits at non-trauma hospitals when compared to Level 2 or Level 3 trauma centers. However, it is still not clear why non-trauma hospitals should have a longer duration than Level 2 or Level 3 trauma centers.

Many of these findings are worthy of further exploration. For example, we believe that since elderly patients frequently present to the ED with multiple complications, they require more ED resources during their visits, which causes them to have a longer duration of visit. Similarly, one plausible explanation for midnight spike in duration on Mondays might be that healthcare personnel change shifts at this time and/or a reduction in other resources between 11 p.m. and midnight. Another plausible explanation might be that healthcare personnel might experience decrease in their labor productivity towards ends of their shifts. Some researchers may claim that our multilevel model estimates produced higher intra-class correlations since the higher the intra-class correlation, the less unique the information provided by each additional patient. Nonetheless, our goal is to show the source of variation between hospitals and patients. Further research using more clustering with fewer cases per cluster is warranted. We also believe that our findings may provide unique opportunities for quality improvements within hospital emergency departments, as we presented sizable variation in duration of T&R ED visits across a wide range of patient and hospital characteristics.

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