TY - JOUR
T1 - Association Between the Emergency Department Length of Stay and in-Hospital Mortality
T2 - A Retrospective Cohort Study
AU - Habib, Hadiki
AU - Sudaryo, Mondastri Korib
N1 - Funding Information:
This study was supported by a PUTI grant of Universitas Indonesia (contract number KB-613/UN2.RST/HKP.05.00/ 2020).
Publisher Copyright:
© 2023 Habib and Sudaryo. This work is published and licensed by Dove Medical Press Limited.
PY - 2023
Y1 - 2023
N2 - Purpose: The number of emergency department (ED) visits and prolonged ED length of stay (LOS) are increasing worldwide. Prolonged ED LOS may be associated with a higher risk of in-hospital mortality. Here, we analysed the association between of ED LOS and the risk of in-hospital mortality in a hospital in Jakarta, Indonesia. Patients and methods: This was a single-centre retrospective cohort study performed in a referral academic hospital in Jakarta, Indonesia. Data on ED visits in 2019 were obtained from the electronic medical records. ED patient was used as the unit of the analysis. The dependent variable was all-cause in-hospital mortality during one’s visit. The main independent variable was ED LOS with respect to approval (<8 h) and prolonged (≥8 h). Potential confounders were sex, age, triage categories, trauma-related case, malignancy-related case, labour-related case, and referral patients from other healthcare facilities. Multivariate logistic regression analysis was performed to evaluate the association of ED LOS and in-hospital mortality after adjusting for other confounders. Results: There were 18,553 participants included in the analysis. The in-hospital mortality was 13.5% among all participants, and 63.5% participants had an ED LOS ≥8 h. Multivariate analysis showed that a prolonged ED LOS was associated with an increased risk of in-hospital mortality (adjusted relative risk, 2.69; 95% confidence interval, 2.40–3.03; P<0.001). Conclusion: Prolonged ED LOS was associated with risk an increased of in-hospital mortality after adjusting for several confounders. In future, hospital service plans should aim to reduce ED LOS and increase patient flow from the ED to in-patient wards. Plain Language Summary: Prolonged emergency department length of stay (ED LOS) was associated with risk of in-hospital mortality in an Indonesia referral hospital; this is the first such reported association. Therefore, reduced ED LOS and increased patient flow to the inpatient ward should be a target for quality improvement in hospital service plans.
AB - Purpose: The number of emergency department (ED) visits and prolonged ED length of stay (LOS) are increasing worldwide. Prolonged ED LOS may be associated with a higher risk of in-hospital mortality. Here, we analysed the association between of ED LOS and the risk of in-hospital mortality in a hospital in Jakarta, Indonesia. Patients and methods: This was a single-centre retrospective cohort study performed in a referral academic hospital in Jakarta, Indonesia. Data on ED visits in 2019 were obtained from the electronic medical records. ED patient was used as the unit of the analysis. The dependent variable was all-cause in-hospital mortality during one’s visit. The main independent variable was ED LOS with respect to approval (<8 h) and prolonged (≥8 h). Potential confounders were sex, age, triage categories, trauma-related case, malignancy-related case, labour-related case, and referral patients from other healthcare facilities. Multivariate logistic regression analysis was performed to evaluate the association of ED LOS and in-hospital mortality after adjusting for other confounders. Results: There were 18,553 participants included in the analysis. The in-hospital mortality was 13.5% among all participants, and 63.5% participants had an ED LOS ≥8 h. Multivariate analysis showed that a prolonged ED LOS was associated with an increased risk of in-hospital mortality (adjusted relative risk, 2.69; 95% confidence interval, 2.40–3.03; P<0.001). Conclusion: Prolonged ED LOS was associated with risk an increased of in-hospital mortality after adjusting for several confounders. In future, hospital service plans should aim to reduce ED LOS and increase patient flow from the ED to in-patient wards. Plain Language Summary: Prolonged emergency department length of stay (ED LOS) was associated with risk of in-hospital mortality in an Indonesia referral hospital; this is the first such reported association. Therefore, reduced ED LOS and increased patient flow to the inpatient ward should be a target for quality improvement in hospital service plans.
KW - emergency department
KW - length of stay
KW - mortality
KW - overcrowding
KW - patient flow
KW - triage
UR - http://www.scopus.com/inward/record.url?scp=85171735343&partnerID=8YFLogxK
U2 - 10.2147/OAEM.S415971
DO - 10.2147/OAEM.S415971
M3 - Article
AN - SCOPUS:85171735343
SN - 1179-1500
VL - 15
SP - 313
EP - 323
JO - Open Access Emergency Medicine
JF - Open Access Emergency Medicine
ER -