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J Korean Soc Emerg Med > Volume 33(3); 2022 > Article
Journal of The Korean Society of Emergency Medicine 2022;33(3): 271-278.
응급실 전담 의사의 내과 입원 결정권과 응급 병동이 응급실 체류 시간에 미치는 영향
박준성 , 장태창 , 이숙희 , 고승현 , 이경우 , 김균무 , 서영우
대구가톨릭대학교 의과대학 응급의학교실
Effects of emergency doctor’s hospitalization authority from internal medicine and utilizing emergency ward on length of stay in emergency department
Jun Sung Park , Tae Chang Jang , Suk Hee Lee , Seung Hyun Ko , Kyung Woo Lee , Gyun Moo Kim , Young Woo Seo
Department of Emergency Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
Correspondence  Tae Chang Jang ,Tel: 053-650-4466, Fax: 053-650-4930, Email: emzzang@cu.ac.kr,
Received: August 9, 2021; Revised: October 5, 2021   Accepted: October 9, 2021.  Published online: June 30, 2022.
ABSTRACT
Objective:
The emergency department (ED) length of stay (LOS) is related to ED overcrowding and emergency practice. This study aimed to investigate the effects of enabling an ED doctor to have the authority to make hospitalization decisions and utilization of the emergency ward on ED LOS.
Method:
This retrospective observational study included patients who were admitted through a local emergency medical center. We compared the ED LOS between the periods' March to July 2018 and March to July 2019. In the latter period, ED doctors were authorized to take decisions on patient hospitalizations from the internal medicine department, and the emergency ward was operated under these new conditions.
Results:
A total of 6,291 patients were included in the study, with 2,934 in 2018 and 3,357 in 2019. In the comparison of ED LOS for internal medicine inpatients by year, there was a significant reduction in the total ED LOS (1,129.0 [491.0-1,618.0] minutes vs. 539.0 [344.0-1,016.25] minutes, P<0.001), LOS before the admission decision (345.0 [198.0-634.0] minutes vs. 280.0 [176.0-442.3] minutes, P<0.001), and LOS after the admission decision (415.0 [147.0-1,089.0] minutes vs. 179.5 [80.0-422.0] minutes, P<0.001). In a subgroup analysis of internal medicine inpatients in 2019, the admission sheets of an ED doctor showed a significant decrease in LOS before the admission decision (268.0 [170.5-424.5] minutes vs. 404.0 [252.0-570.5] minutes, P<0.001). Also, the utilization of the emergency ward showed a significant decrease in LOS after the admission decision (147.0 [75.0-283.0] minutes vs. 187.0 [81.0-460.0] minutes, P<0.001).
Conclusion:
The delegation of hospitalization decisions to the ED doctor and the subsequent utilization of the emergency ward shorten the ED LOS of internal medicine inpatients.
Key words: Emergency department; Length of stay; Hospitalization; Emergency ward
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