Association between the emergency department length of stay and severity-standardized survival among severe emergency patients

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