CAEP/ACMU 2000 Scientific Abstracts: 65-66

CAEP Abstracts

CJEM 2001;2(3):169-187

065 Factors Associated with Patient Length of Stay in the Emergency Department.
Yoon PW, Steiner IP. University of Alberta, Edmonton, Alta.

OBJECTIVES: Canadian Emergency Departments (EDs) are faced with increasing patient volumes and limited resources. This study was performed in order to examine the factors associated with patient length of stay (LOS) in the ED. METHODS: A review of 1047 patient care charts from a continuous 168-hour period in January 1999 was performed. The setting was a Canadian urban tertiary care trauma centre ED that sees over 60,000 visits per year. For each chart, the initial triage score, admit/discharge decision time, departure time, use of ancillary services (laboratory tests and diagnostic imaging), and consultation with specialty services were recorded. Regression analysis was performed to determine which factors were significantly associated with a longer LOS. RESULTS: Of the 1047 charts, 152 (14.5%) were excluded from detailed analysis due to incomplete documentation. The mean time a patient stayed in the ED was 4.8 hours (SD 4.5 h) with a wide variation. Generally, patients triaged with intermediate acuity scores had longer lengths of stay compared to patients with the higher or lower acuity scores (mean times ­ level 1: 2.8h; level 2: 4.6h; level 3: 6.3 h; level 4: 4.6h; level 5: 3.1h). The use of x-ray services prolonged a patient's LOS by a mean of 0.8 hours (p < 0.05) and the ordering of lab work prolonged visits by an average of 2.9 hours (p < 0.05). Patients requiring specialty consultation stayed an average 2.8 hours longer in the ED than those patients without specialty consultation did. A decision to admit the patient to hospital was also associated with an increased LOS (mean 2.7h; p < 0.05). Time of day of arrival did not appear to be a significant factor associated with a patient's total time in the ED. CONCLUSIONS: Our findings suggest that multiple factors contribute to prolonging patient LOS in the ED. Research on the means of reducing these delays in similar settings is urgently needed.
Key words: length-of-stay, utilization

066 Circadian Variation in the Presentation of Patients with Chest Pain to the Emergency Department.
Worrall JC, Ross H. Queen's University, Kingston, Ont.

OBJECTIVES: To determine if there is circadian variation in time of presentation to the ED of patients complaining of chest pain. METHODS: A review of hospital records, conducted at a Canadian tertiary care hospital for the period October 1, 1997 to March 31, 1998. The following groups were identified: 1) anyone whose presenting complaint included "chest pain" or "angina"; 2) anyone who was diagnosed with chest pain, angina, or acute myocardial infarction. Data for 1,979 patients was analyzed by dividing the day into eight 3-hour intervals and into four six-hour intervals. Analysis used the chi-squared test for goodness of fit. RESULTS: The presenting time of all patients in the study showed significant circadian variation both for 3 hour and for 6 hour intervals (each p < 0.0001). The peak intervals were 9:00­11:59 and 12:00­17:59, respectively. The presenting time of patients diagnosed with an ischemic syndrome (angina or acute MI) also showed significant variation for 3 and for 6 hour intervals (each p < 0.0001). The same peaks were observed. For patients diagnosed with an acute MI, the 3 hour interval did not achieve significant variation (p = 0.6), while the 6-hour interval just achieved significant variation (p = 0.44). The 6-hour interval 12:00­17:59 was a peak. There was no significant variation in the per patient probability that a patient had an AMI. CONCLUSIONS: The presentation time to the ED of all patients with chest pain, and of those diagnosed with an ischemic syndrome, does not correlate with previously reported circadian distributions in onset of myocardial ischemia. There was no significant circadian variation in the probability that a patient complaining of chest pain was having a myocardial infarction.
Key words: chest pain, myocardial infarction