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      Patient and hospital characteristics predict prolonged emergency department length of stay and in-hospital mortality: a nationwide analysis in Korea

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          Abstract

          Background

          Prolonged emergency department length of stay (EDLOS) in critically ill patients leads to increased mortality. This nationwide study investigated patient and hospital characteristics associated with prolonged EDLOS and in-hospital mortality in adult patients admitted from the emergency department (ED) to the intensive care unit (ICU).

          Methods

          We conducted a retrospective cohort study using data from the National Emergency Department Information System. Prolonged EDLOS was defined as an EDLOS of ≥ 6 h. We constructed multivariate logistic regression models of patient and hospital variables as predictors of prolonged EDLOS and in-hospital mortality.

          Results

          Between 2016 and 2019, 657,622 adult patients were admitted to the ICU from the ED, representing 2.4% of all ED presentations. The median EDLOS of the overall study population was 3.3 h (interquartile range, 1.9–6.1 h) and 25.3% of patients had a prolonged EDLOS. Patient characteristics associated with prolonged EDLOS included night-time ED presentation and Charlson comorbidity index (CCI) score of 1 or higher. Hospital characteristics associated with prolonged EDLOS included a greater number of staffed beds and a higher ED level. Prolonged EDLOS was associated with in-hospital mortality after adjustment for selected confounders (adjusted odds ratio: 1.18, 95% confidence interval: 1.16–1.20). Patient characteristics associated with in-hospital mortality included age ≥ 65 years, transferred-in, artificially ventilated in the ED, assignment of initial triage to more urgency, and CCI score of 1 or higher. Hospital characteristics associated with in-hospital mortality included a lesser number of staffed beds and a lower ED level.

          Conclusions

          In this nationwide study, 25.3% of adult patients admitted to the ICU from the ED had a prolonged EDLOS, which in turn was significantly associated with an increased in-hospital mortality risk. Hospital characteristics, including the number of staffed beds and the ED level, were associated with prolonged EDLOS and in-hospital mortality.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s12873-022-00745-y.

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          Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries.

          Hude Quan, Bing Li, Chantal M Couris … (2011)
          With advances in the effectiveness of treatment and disease management, the contribution of chronic comorbid diseases (comorbidities) found within the Charlson comorbidity index to mortality is likely to have changed since development of the index in 1984. The authors reevaluated the Charlson index and reassigned weights to each condition by identifying and following patients to observe mortality within 1 year after hospital discharge. They applied the updated index and weights to hospital discharge data from 6 countries and tested for their ability to predict in-hospital mortality. Compared with the original Charlson weights, weights generated from the Calgary, Alberta, Canada, data (2004) were 0 for 5 comorbidities, decreased for 3 comorbidities, increased for 4 comorbidities, and did not change for 5 comorbidities. The C statistics for discriminating in-hospital mortality between the new score generated from the 12 comorbidities and the Charlson score were 0.825 (new) and 0.808 (old), respectively, in Australian data (2008), 0.828 and 0.825 in Canadian data (2008), 0.878 and 0.882 in French data (2004), 0.727 and 0.723 in Japanese data (2008), 0.831 and 0.836 in New Zealand data (2008), and 0.869 and 0.876 in Swiss data (2008). The updated index of 12 comorbidities showed good-to-excellent discrimination in predicting in-hospital mortality in data from 6 countries and may be more appropriate for use with more recent administrative data. © The Author 2011. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved.
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            Emergency department crowding: A systematic review of causes, consequences and solutions

            Claire Morley, Maria Unwin, Gregory M. Peterson … (2018)
            Background Emergency department crowding is a major global healthcare issue. There is much debate as to the causes of the phenomenon, leading to difficulties in developing successful, targeted solutions. Aim The aim of this systematic review was to critically analyse and summarise the findings of peer-reviewed research studies investigating the causes and consequences of, and solutions to, emergency department crowding. Method The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. A structured search of four databases (Medline, CINAHL, EMBASE and Web of Science) was undertaken to identify peer-reviewed research publications aimed at investigating the causes or consequences of, or solutions to, emergency department crowding, published between January 2000 and June 2018. Two reviewers used validated critical appraisal tools to independently assess the quality of the studies. The study protocol was registered with the International prospective register of systematic reviews (PROSPERO 2017: CRD42017073439). Results From 4,131 identified studies and 162 full text reviews, 102 studies met the inclusion criteria. The majority were retrospective cohort studies, with the greatest proportion (51%) trialling or modelling potential solutions to emergency department crowding. Fourteen studies examined causes and 40 investigated consequences. Two studies looked at both causes and consequences, and two investigated causes and solutions. Conclusions The negative consequences of ED crowding are well established, including poorer patient outcomes and the inability of staff to adhere to guideline-recommended treatment. This review identified a mismatch between causes and solutions. The majority of identified causes related to the number and type of people attending ED and timely discharge from ED, while reported solutions focused on efficient patient flow within the ED. Solutions aimed at the introduction of whole-of-system initiatives to meet timed patient disposition targets, as well as extended hours of primary care, demonstrated promising outcomes. While the review identified increased presentations by the elderly with complex and chronic conditions as an emerging and widespread driver of crowding, more research is required to isolate the precise local factors leading to ED crowding, with system-wide solutions tailored to address identified causes.
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              Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine

              Maurizio Cecconi, Daniel De Backer, Massimo Antonelli … (2014)
              Objective Circulatory shock is a life-threatening syndrome resulting in multiorgan failure and a high mortality rate. The aim of this consensus is to provide support to the bedside clinician regarding the diagnosis, management and monitoring of shock. Methods The European Society of Intensive Care Medicine invited 12 experts to form a Task Force to update a previous consensus (Antonelli et al.: Intensive Care Med 33:575–590, 2007). The same five questions addressed in the earlier consensus were used as the outline for the literature search and review, with the aim of the Task Force to produce statements based on the available literature and evidence. These questions were: (1) What are the epidemiologic and pathophysiologic features of shock in the intensive care unit? (2) Should we monitor preload and fluid responsiveness in shock? (3) How and when should we monitor stroke volume or cardiac output in shock? (4) What markers of the regional and microcirculation can be monitored, and how can cellular function be assessed in shock? (5) What is the evidence for using hemodynamic monitoring to direct therapy in shock? Four types of statements were used: definition, recommendation, best practice and statement of fact. Results Forty-four statements were made. The main new statements include: (1) statements on individualizing blood pressure targets; (2) statements on the assessment and prediction of fluid responsiveness; (3) statements on the use of echocardiography and hemodynamic monitoring. Conclusions This consensus provides 44 statements that can be used at the bedside to diagnose, treat and monitor patients with shock.
              Article 0 comments Cited 285 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Ho Kyung Sung: hokyungsung@nmc.or.kr
                Journal
                Journal ID (nlm-ta): BMC Emerg Med
                Journal ID (iso-abbrev): BMC Emerg Med
                Title: BMC Emergency Medicine
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1471-227X
                Publication date (Electronic): 21 November 2022
                Publication date PMC-release: 21 November 2022
                Publication date Collection: 2022
                Volume: 22
                Electronic Location Identifier: 183
                Affiliations
                [1 ]GRID grid.415619.e, ISNI 0000 0004 1773 6903, Public Health Research Institute, National Medical Center, ; 245 Eulgi-Ro, Jung-Gu, Seoul, 04564 Korea
                [2 ]GRID grid.254230.2, ISNI 0000 0001 0722 6377, Department of Internal Medicine, , Chungnam National University School of Medicine, ; Daejeon, Korea
                [3 ]GRID grid.254230.2, ISNI 0000 0001 0722 6377, Department of Pulmonary and Critical Care Medicine, , Chungnam National University Sejong Hospital, ; Sejong, Korea
                [4 ]GRID grid.415520.7, ISNI 0000 0004 0642 340X, Department of Emergency Medicine, , Seoul Medical Center, ; Seoul, Korea
                [5 ]GRID grid.415619.e, ISNI 0000 0004 1773 6903, Department of Trauma Surgery, , National Medical Center, ; Seoul, Korea
                [6 ]GRID grid.415619.e, ISNI 0000 0004 1773 6903, National Emergency Medical Center, National Medical Center, ; Seoul, Korea
                [7 ]GRID grid.415619.e, ISNI 0000 0004 1773 6903, Department of Pediatrics, , National Medical Center, ; Seoul, Korea
                [8 ]GRID grid.415619.e, ISNI 0000 0004 1773 6903, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, , National Medical Center, ; Seoul, Korea
                Article
                Publisher ID: 745
                DOI: 10.1186/s12873-022-00745-y
                PMC ID: 9677700
                PubMed ID: 36411433
                SO-VID: 212e1fb0-b050-4163-8853-beb19c302450
                Copyright © © The Author(s) 2022
                License:

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                Date received : 9 August 2022
                Date accepted : 4 November 2022
                Categories
                Subject: Research
                Custom metadata
                issue-copyright-statement © The Author(s) 2022

                ScienceOpen disciplines: Emergency medicine & Trauma
                Keywords: emergency department,critical care,intensive care unit,length of stay,in-hospital mortality
                Data availability:
                ScienceOpen disciplines: Emergency medicine & Trauma
                Keywords: emergency department, critical care, intensive care unit, length of stay, in-hospital mortality

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