The impact of emergency department length of stay on the outcomes of trauma patients requiring hospitalization: a retrospective observational study

BACKGROUND: We aimed to explore the impact of the emergency department length of stay(EDLOS) on the outcome of trauma patients.METHODS: A retrospective study was conducted on all trauma patients requiring hospitalization between 2015 and 2019. Patients were categorized into 4 groups based on the EDLOS(<4 h, 4–12 h,12–24 h, and >24 h). Data were analyzed using Chi-square test(categorical variables), Student’s t-test(continuous variables), correlation coefficient, analysis of variance and multivariate logistic regression analysis for identifying predictors of short EDLOS and hospital mortality.RESULTS: The study involved 7,026 patients with a mean age of 32.1±15.6 years. Onefifth of patients had a short EDLOS(<4 h) and had higher level trauma team T1 activation(TTA-1), higher Injury Severity Score(ISS), higher shock index(SI), and more head injuries than the other groups(P=0.001). Patients with an EDLOS >24 h were older(P=0.001) and had more comorbidities(P=0.001) and fewer deaths(P=0.001). Multivariate regression analysis showed that the predictors of short EDLOS were female gender, GCS, SI, hemoglobin level, ISS, and blood transfusion. The predictors of mortality were TTA-1(odds ratio [OR]=4.081, 95%CI: 2.364–7.045), head injury(OR=3.920, 95%CI: 2.413–6.368), blood transfusion(OR=2.773, 95%CI: 1.668–4.609), SI(OR=2.132, 95%CI: 1.364–3.332), ISS(OR=1.077, 95%CI: 1.057–1.096), and age(OR=1.040, 95%CI: 1.026–1.054). CONCLUSIONS: Patients with shorter EDLOS had different baseline characteristics and hospital outcomes compared with patients with longer EDLOS. Patients with prolonged EDLOS had better outcomes;however, the burden of prolonged boarding in the ED needs further elaboration.

Incidence trends and predictors for cost and average lengths of stay in colorectal cancer surgery

AIM:To evaluate the changing trends and outcomes of colorectal cancer(CRC)surgery performed at a large single institution in Taiwan.METHODS:This study retrospectively analyzed 778patients who received colorectal cancer surgery at E-Da Hospital in Taiwan from 2004 to 2009.These patients were from health examination,inpatient or emergency settings.The following attributes were analyzed in patients who had undergone CRC surgical procedures:gender,age,source,surgical type,tumor number,tumor size,number of lymph node metastasis,pathologic differentiation,chemotherapy,distant metastases,tumor site,tumor stage,average hospitalization cost and average lengths of stay(ALOS).The odds ratio and95%confidence intervals were calculated to assess the relative rate of change.Regression models were employed to predict average hospitalization cost and ALOS.RESULTS:The study sample included 458(58.87%)males and 320(41.13%)females with a mean age of64.53 years(standard deviation,12.33 years;range,28-86 years).The principal patient source came from inpatient and emergency room(96.02%).The principal tumor sites were noted at the sigmoid colon(35.73%)and rectum(30.46%).Most patients exhibited a tumor stage of 2(37.28%)or 3(34.19%).The number of new CRC surgeries performed per 100000 persons was12.21 in 2004 and gradually increased to 17.89 in 2009,representing a change of 46.52%.During the same period,the average hospitalization cost and ALOS decreased from$5303 to$4062 and from 19.7 to 14.4 d,respectively.The following factors were associated with considerably decreased hospital resource utilization:age,source,surgical type,tumor size,tumor site,and tumor stage.CONCLUSION:These results can be generalized to patient populations elsewhere in Taiwan and to other countries with similar patient profiles.

Emergency Department Waiting Times and Determinants of Prolonged Length of Stay in a Botswana Referral Hospital

Introduction: Emergency medicine is a critical component of quality public health service. In fact length of stay and waiting times in the Emergency department are key indicators of quality. The aim of this study was to determine waiting times and determinants of prolonged length of stay (LOS) in the Princess Marina Hospital Emergency Department. Methods: This was a retrospective observational study. It was done at Princess Marina, a referral hospital in Gaborone, Botswana. Triage forms of patients who presented between 19/11/ 2018 and 18/12/2018 were reviewed. Data from patient files was used to determine time duration from triage to being reviewed by a doctor, time duration from review by emergency doctor to patients’ disposition and the time duration from patient’s triage to disposition (length of stay). Prolonged length of stay was defined as duration > 6 hours. Results: A total of 1052 files repre- senting patients seen over a 1-month period were reviewed. 72.5% of the patients had a prolonged length of stay. The median emergency doctor waiting time was 4.5 hours (IQR 1.6 - 8.3 hours) and the maximum was 27.1 hours. The median length of stay in the emergency department was 9.6 hours (IQR 5.8 - 14.6 hours) and the maximum was 45.9 hours. Patient’s age (AOR 1.01), mental status (AOR 0.61), admission to internal medicine service (AOR 5.12) and pediatrics admissions (AOR 0.11) were significant predictors of prolonged length of stay in the emergency department. Conclusion: Princess Marina Hospital emergency department waiting times and length of stay are long. Age, normal mental status and internal medicine admission were independent predictors of prolonged stay (>6 hours). Admission to the pediatrics service was associated with shorter length of stay. There is a need for interventions to address the long waiting times and length of stay. Interventions should particularly focus on the identified predictors.

Language affects length of stay in emergency departments in Queensland public hospitals

BACKGROUND:A long length of stay(LOS) in the emergency department(ED) associated with overcrowding has been found to adversely affect the quality of ED care.The objective of this study is to determine whether patients who speak a language other than English at home have a longer LOS in EDs compared to those whose speak only English at home.METHODS:A secondary data analysis of a Queensland state-wide hospital EDs dataset(Emergency Department Information System) was conducted for the period,1 January 2008 to 31 December 2010.RESULTS:The interpreter requirement was the highest among Vietnamese speakers(23.1%)followed by Chinese(19.8%) and Arabic speakers(18.7%).There were significant differences in the distributions of the departure statuses among the language groups(Chi-squared=3236.88,P<0.001).Compared with English speakers,the Beta coefficient for the LOS in the EDs measured in minutes was among Vietnamese,26.3(95%Cl:22.1-30.5);Arabic,10.3(95%Cl:7.3-13.2);Spanish,9.4(95%CI:7.1-11.7);Chinese,8.6(95%Cl:2.6-14.6);Hindi,4.0(95%Cl:2.2-5.7);Italian,3.5(95%Cl:1.6-5.4);and German,2.7(95%Cl:1.0-4.4).The final regression model explained 17%of the variability in LOS.CONCLUSION:There is a close relationship between the language spoken at home and the LOS at EDs,indicating that language could be an important predictor of prolonged LOS in EDs and improving language services might reduce LOS and ease overcrowding in EDs in Queensland's public hospitals.

The Correlation of Hospital Operational Efficiency and Average Length of Stay in China: A Study Based on Provincial Level Data

Objective: To measure the hospital operation efficiency, study the correlation between average length of stay and hospital operation efficiency, analyze the importance of shortening average length of stay to the improvement of the hospital operation efficiency and put forward relevant policy suggestion. Methods: Based on China provincial panel data from 2003 to 2012, the hospital operation efficiencies are calculated using Super Efficiency Data Envelopment Analysis model, and the correlation between average length of stay and hospital operation efficiency is tested using Spearman rank correlation coefficient test. Results: From 2003 to 2012, the average of national hospital operation efficiency was increasing slowly and the hospital operations were inefficient in most of the areas. The national hospital operation efficiency is negatively correlated to the average length of stay. Conclusion: Measures should be taken to set average length of stay in a scientific and reasonable way, improve social and economic benefits based on the improvement of efficiency.

Waiting Times and Length of Stay of Trauma Patients in a Botswana Referral Hospital Emergency Department

Background: Mortality and morbidity due to trauma are a significant public health challenge. There is paucity of data on the waiting times and length of stay (LOS) of trauma patients in emergency departments in Botswana. The aim of this study was to determine the Emergency Department (ED) waiting times and LOS of trauma patients at Princess Marina Hospital in Gaborone, Botswana. Methods: This was a retrospective medical records review of waiting times (time from triage to review by ED medical officer) and LOS (time from triage to disposition from the emergency department). The waiting times for the different assigned acuities were assessed against the South African Triage System (SATS) standards. All trauma patients seen from 19/11/2018 to 18/12/2018 were included in the study. Prolonged length of stay was defined as duration > 6 hours. Categorical data was summarized with frequencies while numeric data was summarized with medians and interquartile ranges. Results: A total of 187 trauma patients’ files were analyzed. Of these, 72 (38.5%) were females. The median waiting time was 3.8 hours and the maximum was 19.2 hours. The median length of stay (LOS) was 8.8 hours with a maximum of 37.2 hours. Only 53 (28.3%) of the participants had a LOS of less than 6 hours. None of the emergent patients were seen immediately. Only 5 (4.0%) of the very urgent patients were seen within the target of 10 minutes. Finally, only 10 (20.4%) of urgent patients were seen within the target time of 1 hour. Conclusion: The waiting times and length of stay in Princess Marina Hospital were mostly above the recommended standards. Urgent interventions are needed to reduce waiting times and length of stay for trauma patients. More studies are needed to explore the sources of delay and investigate possible solutions to this public health challenge.

Expedited Discharge of Patients with Diabetic Ketoacidosis in an Emergency Department Short Stay Unit

Aim: Review of presentation, management and outcome of patients admitted with Diabetic Ketoacidosis (DKA) to an emergency department short stay unit with expedited discharge. Methods: All admitted patients with a discharge diagnosis of “Diabetic Ketoacidosis”, were identified by the file auditing section in the Emergency Department. Data obtained from the medical records were collected using an explicit chart review from January 2012 to June 2013. Data included clinical monitoring, investigations performed, the type and amount of intravenous fluids given, the insulin regime, potassium supplementation and outcome. Results: Out of a total of 120 patients labelled as DKA or hyperglycaemia on arrival, hundred patients fulfilled the criteria for DKA. In the population studied the mean age was 25 years with a male predominance. Eighty-two patients suffered from Type 1 Diabetes Mellitus (T1DM) whilst eighteen patients had Type 2 Diabetes Mellitus (T2DM). Sixteen patients were newly diagnosed during the present admission. Seventy-six (76%) patients were on insulin. The insulin regimen and potassium supplementation were followed as per protocol in all patients. All the patients except one were given intravenous fluid according to protocol. Parameters were monitored adequately except fluid input and output monitoring. The median length of stay in the short stay unit was 1.5833 days. There was no return visit within one week of discharge. Conclusion: The median length of stay was short and there were no documented complications or deaths during the stay. There was poor compliance with documentation of fluid input and output. In this population, the short stay model of care appeared to be safe and efficient.

Cost analysis of radical resection of malignant breast tumors under the China Healthcare Security Diagnosis Related Groups payment system

BACKGROUND Breast cancer is one of the most common malignant tumors in women worldwide and poses a severe threat to their health.Therefore,this study examined patients who underwent breast cancer surgery,analyzed hospitalization costs and structure,and explored the impact of China Healthcare Security Diagnosis Related Groups(CHS-DRG)management on patient costs.It aimed to provide medical institutions with ways to reduce costs,optimize cost structures,reduce patient burden,and improve service efficiency.AIM To study the CHS-DRG payment system’s impact on breast cancer surgery costs.METHODS Using the CHS-DRG(version 1.1)grouping criteria,4073 patients,who underwent the radical resection of breast malignant tumors from January to December 2023,were included in the JA29 group;1028 patients were part of the CHS-DRG payment system,unlike the rest.Through an independent sample t-test,the length of hospital stay as well as total hospitalization,medicine and consumables,medical,nursing,medical technology,and management expenses were compared.Pearson’s correlation coefficient was used to test the cost correlation.RESULTS In terms of hospitalization expenses,patients in the CHS-DRG payment group had lower medical,nursing,and management expenses than those in the diagnosis-related group(DRG)non-payment group.For patients in the DRG payment group,the factors affecting the total hospitalization cost,in descending order of relevance,were medicine and consumable costs,consumable costs,medicine costs,medical costs,medical technology costs,management costs,nursing costs,and length of hospital stay.For patients in the DRG nonpayment group,the factors affecting the total hospitalization expenses in descending order of relevance were medicines and consumable expenses,consumable expenses,medical technology expenses,the cost of medicines,medical expenses,nursing expenses,length of hospital stay,and management expenses.CONCLUSION The CHS-DRG system can help control and reduce unnecessary medical expenses by controlling medicine costs,medical consumable costs,and the length of hospital stay while ensuring medical safety.

Surgical treatment of liver cancer and pancreatic cancer under the China Healthcare Security Diagnosis Related Groups payment system

BACKGROUND Data from the World Health Organization’s International Agency for Research on Cancer reported that China had the highest prevalence of cancer and cancer deaths in 2022.Liver and pancreatic cancers accounted for the highest number of new cases.Real-world data(RWD)is now widely preferred to traditional clinical trials in various fields of medicine and healthcare,as the traditional research approach often involves highly selected populations and interventions and controls that are strictly regulated.Additionally,research results from the RWD match global reality better than those from traditional clinical trials.AIM To analyze the cost disparity between surgical treatments for liver and pancreatic cancer under various factors.METHODS This study analyzed RWD 1137 cases within the HB1 group(patients who underwent pancreatectomy,hepatectomy,and/or shunt surgery)in 2023.It distinguished different expenditure categories,including medical,nursing,technical,management,drug,and consumable costs.Additionally,it assessed the contribution of each expenditure category to total hospital costs and performed cross-group comparisons using the non-parametric Kruskal–Wallis test.This study used the Steel–Dwass test for post-hoc multiple comparisons and the Spearman correlation coefficient to examine the relationships between variables.RESULTS The study found that in HB11 and HB13,the total hospitalization costs were significantly higher for pancreaticoduodenectomy than for pancreatectomy and hepatectomy.Although no significant difference was observed in the length of hospital stay between patients who underwent pancreaticoduodenectomy and pancreatectomy,both were significantly longer than those who underwent liver resection.In HB15,no significant difference was observed in the total cost of hospitalization between pancreaticoduodenectomy and pancreatectomy;however,both were significantly higher than those in hepatectomy.Additionally,the length of hospital stay was significantly longer for patients who underwent pancreaticoduodenectomy than for those who underwent pancreatectomy or liver resection.CONCLUSION China Healthcare Security Diagnosis Related Groups payment system positively impacts liver and pancreatic cancer surgeries by improving medical quality and controlling costs.Further research could refine this grouping system and ensure continuous effectiveness and sustainability.

Analysis of Waiting Time in Emergency Department of Al-Noor Specialist Hospital, Makkah, Saudi Arabia

Emergency Department (ED) in Alnoor Hospital is considered the pulsating unit in the hospital by facing a daily challenge through a huge exposure to number of patients round between 500 - 700 per day in average. With this busy service in ED, our study emerges to measure the quality of provided services to patients in term of measuring the total length of stay time (LOS) in ED and its influencing factors. This is a prospective study aiming to estimate the average time patients spend in ED of Alnoor Hospital during the month of January (2013). In addition, it inspects factors influencing the LOS. The questionnaire which conducted and filled by emergency team over all patients was consisted of the following data: arrival time to ED, initial time of assessment by nurse, initial time of assessment by doctor, time of arrival to specific area, consultation time, arrival time of consulted specialty, time of laboratory investigation, time of radiological investigation, time of final disposition and time of physical disposition. For the 7604 patient visits analyzed, mean ED LOS was 3.02 hour (SD = 5.03 hour). About half of the patients spent less than 59 minutes (44%), 32.6% spent 1 to 3:59 hour, 15.2% spent 4 to 7:59 hour, and 8.2% of the patients spent more than 8 hours. A priceless such study will offer an opportunity to evaluate the recent ED performance and assist to adapt future optimization strategies to improve the quality of services provided to the patient.

The emergency department length of stay: Is the time running out?

Purpose: To examine the relationships between emergency department length of stay (EDLOS) with hospital length of stay (HLOS) and clinical outcome in hemodynamically stable trauma patients. Methods: Prospective data collected for 2 years from consecutive trauma patients admitted to the trauma resuscitation bay. Only stable blunt trauma patients with appropriate trauma triage criteria requiring trauma teamactivationwere included in the study. EDLOSwas determined short if patient spent less than 2 h in the emergency department (ER) and long for more than 2 h. Results: A total of 248 patients were enrolled in the study. The mean total EDLOS was 125 min (range 78 e180). Injury severity score (ISS) were significantly higher in the long EDLOS group (17 ± 13 versus 11 ± 9, p < 0.001). However, when leveled according to ISS, there were no differences in mean in diagnostic workup, admission rate to intensive care unit (ICU) or HLOS between the short and long EDLOS groups. Conclusion: EDLOS is not a significant parameter for HLOS in stable trauma patients.

Developing Additional Hospital Capacity at the Community Level

Hospitals in the United States are being challenged to provide the capacity for adult medicine and surgery care. The study suggested that the hospitals of Syracuse, New York have generated additional inpatient capacity through a number of efforts. One program involved moving some low severity of illness inpatient procedures to ambulatory care. A different approach has also avoided inpatient utilization by diverting incoming ambulances to different providers. The third program evaluated in the study, length of stay reduction, was a different type of initiative. It has generated additional inpatient capacity by reducing the amount of inpatient care provided. In effect, it has increased inpatient capacity by addressing the efficiency of care. These programs illustrate the potential for improving hospital capacity at the community level. Each of them was developed by acute care providers using local services.

北京佑安医院降低平均住院日的管理措施研究

目的探讨首都医科大学附属北京佑安医院实施平均住院日管理的效果。方法首都医科大学附属北京佑安医院在2022年1月起采取建立集中预约平台、成立住院服务中心、实时沟通机制、积极开展日间手术和微创手术、深入推进临床路径和单病种管理、优化多学科诊疗模式等多项措施综合管控平均住院日,比较2021年1—12月和2022年1—12月病案首页数据,对全院、重点科室、前20位疾病的平均住院日相关数据进行统计分析。结果采取多措并举后,2022年1—12月全院平均住院日、重点科室平均住院日和前20位疾病平均住院日均较2021年1—12月明显下降,2022年1—12月平均住院日由9.49 d降至8.50 d。结论多部门联动后优化措施可有效缩短平均住院日。

平均住院日的管控及成效分析

目的探究以临床科室为单位考核的管控方式对平均住院日的管控成效。方法选取2021年1月—2023年6月南通市肿瘤医院80名医务人员为研究对象。2021年1—12月实行常规平均住院日管理,2022年1月—2023年6月实行临床科室为单位考核的管控方式,比较2021—2023年各科室平均住院日情况及医疗运行指标(病床使用率、床位周转次数、床位使用指数),对比管控前后医务人员综合素质评分。结果与2021年相比,2022年各季度以及2023年第一季度、第二季度各科室平均住院日均有不同程度下降,患者病床使用率、床位周转次数以及床位使用指数总体上有升高趋势。管控后医务人员专业技能、诊疗效率、工作态度、团队协作能力、服务意识评分均高于管控前组,差异有统计学意义(P均<0.05)。结论采用临床科室为单位考核的管控方式,能够缩短临床科室平均住院日,增加床位周转次数,提高患者病床使用率。

缩短手术科室平均住院日举措及成效

本文以上海某医院为研究对象,分析缩短手术科室平均住院日的举措;评估举措实施后对缩短手术科室平均住院日和术前平均住院日的成效;讨论缩短平均住院日的目的和意义;对大型综合型医院缩短平均住院日提高医疗率具有借鉴意义。

平均住科日作为绩效指标的有效性研究

目的研究平均住科日作为绩效指标的有效性。方法通过调查1个月的数据比较平均住院日与平均住科日及相关指标,进行统计分析,确认其差异状态。结果得到医院1个月各科室及全院的相关指标数据列表及统计分析结果。结论平均住科日和出科人次可以作为科室绩效评价的有效指标,但用于医院绩效评价时平均住科日与平均住院日差别不明显。

如何精确统计科室平均住院日

目的使科室平均住院日的计算更加科学、合理。方法对病人转科现象进行深入分析,抓住病人床位费与科室占床日之间的关系,按科室是否有床位费为条件判断病人是否在此科室住过院,建立合理的计算公式。结果有效降低了平均住院日,实现了科室平均住院日的精确统计。

基于CMI值制定医院科室平均住院日目标

合理控制平均住院日能够提高医疗工作效率,有效控制医疗费用,改善医疗经济效益。所以平均住院日通常是医疗质量管理的核心指标,而怎样科学合理地制订医院内各科室的平均住院日目标是一个难题。传统的方法很难兼顾到科室间病种的不同所导致的差异,DRGs正是一个解决不同病种之间可比性的方法。DRGs可以给科室内每个病例赋予权重,即病例诊治的难度系数,从而得到科室诊治病例的综合难度CMI值。作者尝试将CMI指标应用于科室平均住院日的目标管理,得到了较为合理的结果。

整体护理在产科失血性休克早期救治中的应用

目的探讨整体护理干预方法对妇产科失血性休克早期患者的影响。方法回顾性分析我院收治的148例妇产科失血性休克早期患者的临床护理资料,根据护理方法的不同,将患者分为观察组78例和对照组70例。观察组采取整体护理模式,对照组采取常规护理方法,对两组患者的平均住院日、护理满意度、出院前的SAS及SDS评分进行比较分析。结果观察组的平均住院日为(10.6±3.8)天、对照组为(23.1±5.9)天,两组差异有显著统计学意义(P<0.01)。观察组的护理满意度为94.87%、对照组为81.43%,两组差异有统计学意义(P<0.05)。两组患者在出院前的SAS评分、SDS评分均较病情稳定时降低(P<0.05),但观察组降低更显著(P<0.01)。结论在妇产科失血性休克患者的救治中采用整体护理模式,有利于改善患者的负性心理情绪,提高护理满意度,有助于机体康复,缩短平均住院日。

基于间断时间序列模型的眼科日间手术对平均住院日影响的研究

目的评价日间手术的开展对平均住院日的影响,为医院管理提供参考。方法采用间断时间序列模型,以2015年1月—2021年10月在本院眼科接受白内障手术患者作为研究对象,其中2015年1月1日—2018年2月28日为实施前时间段,共收治2471例患者;2018年3月1日—2021年10月31日作为政策实施后的效果观察时间段,共收治2989例患者。以月为单位分析开展日间手术前后平均住院日变化趋势,同时收集了同期科室平均住院日数据并分析。结果政策实施前共完成2471例白内障手术,平均住院日为(3.86±1.07)天,同期科室平均住院日为(5.39±1.38)天;政策实施后共完成2989例白内障手术,平均值住院日为(1.48±0.19)天,较实施前降低了2.38天,扣除趋势因素影响,实际降低了3.70天(P<0.01),较期初降低了66.62%;同时眼科科室平均住院日为(2.87±0.42)天,较实施前降低了2.52天,扣除趋势等因素影响后实际降低4.20天(P<0.01),较期初降低了55.63%。结论日间手术的开展对缩短平均住院日,提高医疗资源利用率具有积极意义,非常值得推广。