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J Korean Soc Emerg Med > Volume 33(1); 2022 > Article
Journal of The Korean Society of Emergency Medicine 2022;33(1): 69-83.
중증응급환자의 응급의료센터 재실시간에 따른 중증도 표준화 생존 분석
강사율1 , 최유리1,2 , 이성우3 , 한갑수3 , 김수진3 , 김원영4 , 강형구5 , 홍은석6 , 정진우1,2
1동아대학교병원 응급의학과
2동아대학교 의과대학 응급의학교실
3고려대학교 의과대학 응급의학교실
4울산대학교 의과대학 서울아산병원 응급의학과
5한양대학교 의과대학 응급의학교실
6울산대학교 의과대학 울산대학교병원 응급의학과
Association between the emergency department length of stay and severity-standardized survival among severe emergency patients
Sayul Kang1 , Yuri Choi1,2 , Sung Woo Lee3 , Kap Su Han3 , Su Jin Kim3 , Won Young Kim4 , Hyunggoo Kang5 , Eun Seog Hong6 , Jinwoo Jeong1,2
1Department of Emergency Medicine, Dong-A University Hospital, Busan, Korea
2Department of Emergency Medicine, Dong-A University College of Medicine, Busan, Korea
3Department of Emergency Medicine, Korea University College of Medicine, Seoul, Korea
4Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
5Department of Emergency Medicine, Hanyang University College of Medicine, Seoul, Korea
6Department of Emergency Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
Correspondence  Jinwoo Jeong ,Tel: 051-240-5590, Fax: 051-240-5309, Email: advanced@lifesupport.pe.kr,
Received: April 6, 2021; Revised: April 26, 2021   Accepted: May 3, 2021.  Published online: February 28, 2022.
ABSTRACT
Objective:
The length of stay in the emergency department (ED) is a major contributor to ED overcrowding, which in turn negatively affects the quality of emergency care. Several efforts have been made to reduce the ED length of stay (ED-LOS), including a mandatory target to limit ED-LOS within certain parameters. However, the association between ED-LOS and treatment results is yet to be clarified. The authors investigated the influence of ED-LOS on patient survival by comparing severity-adjusted survival.
Method:
This study was a retrospective analysis of data registered in 2018 in the National Emergency Department Information System (NEDIS). Cases registered by the regional and local emergency centers were included for analysis. The standardized W scores (Ws) based on the Emergency Department Initial Evaluation Score were used to assess treatment outcomes represented by severity-standardized survival, and the correlation between the Ws and the ED-LOS was analyzed.
Results:
A total of 2,281,526 cases were included for analysis. The overall mortality comprised 52,284 cases (2.3%) and the median ED-LOS was 165 minutes (interquartile range, 96-301). Although a longer ED-LOS was associated with poorer outcomes overall, the association was not apparent when an analysis of cases eligible for ED-LOS evaluation in the national evaluation program was carried out. Moreover, in the analysis of severe cases with a predicted survival probability of less than 0.9, an ED-LOS shorter than 6 hours was associated with significantly poorer severity-adjusted survival.
Conclusion:
The study revealed that the current ED-LOS criteria used in the national evaluation program were not associated with better survival.
Key words: Program evaluation; Quality improvement; Emergency service, hospital; Length of stay; Survival
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