PROPORTION OF EMERGENCY VISITS WITH PROLONGED LENGTH OF STAY AND ASSOCIATED FACTORS IN AL WAKRA HOSPITAL: A RETROSPECTIVE COHORT STUDY

Abstract

Background: Length of stay (LOS) in emergency department (ED) defined as "the time from patient's registration in ED to discharge" is a key healthcare quality measure in ED. Prolonged LOS has been linked with adverse health outcomes and patient's dissatisfaction. Several countries have implemented a maximum LOS targets ranging from four to six hours. However, several reports from different countries show that significant proportions of ED patients breach the LOS targets. Currently, the healthcare system in Qatar has a four-hour waiting time target in ED. The main aim of this thesis was to estimate the proportion of patients exceeding the four-hour LOS target in adult ED in AWH and identify associated factors. The objectives of the thesis were: (a) to identify the overall proportion of ED visits that breach the 4-hour LOS target between January and April 2019, inclusive; (b) to identify any variations in monthly proportions of ED visits breaching the four-hour LOS target between January and April 2019, inclusive; (c) to identify any differences in LOS time in main processes within patient flow in ED by breaching the LOS target status among discharged and admitted patients; (d) To identify the main factors (patient- level factors and throughput process factors in ED and the hospital) associated with breaching the 4-hour LOS target. Method: A retrospective cohort study design was used to review all adult ED visits for patients aged 14 years or older in AWH from January 1st, 2019 to April 30th, 2019, inclusive. The computerized health information system (CERNER) was used to extract study data. The main outcome variables were LOS in ED and the breaching status of the 4- hour LOS target on daily basis as a binary variable (not-breached=? 4 hours, breached =>4 hours), where the data were collected on daily basis. Process template and logistic regression were used to analyze the data. Results: The proportion of patients exceeded the LOS was 37% with a median LOS of 423 minutes. Among longer stay patients (>4 hours), as compared to short stay patients (<=4 hours) visits, Visits that breached the target had higher 80th percentile LOS time from time seen by nurse to being seen by the physician, time from seen by the physician until discharge, x-ray time, US time, and CT time. Among the admitted patients, the same differences were observed plus longer 80th percentile times from seen by the physician to a decision to admit is made and from admission decision to actual admission to a ward between visits that breached and "not-breached" the target. Older age, male gender, non-Qatari nationality, arrival by ambulance, night shift, month of visiting the ED, triage acuity (less argent and urgent), increasing number of consultations with consultants, performing laboratory tests and radiologic examination, and inpatient admission were independent predictors of breaching the four-hour LOS target. Conclusion: One (1) out of three (3) patients attending the ED at AWH breaches the four-hour LOS target. The main processes in patient journey that accounted for a major part of LOS in ED was waiting time to see the physician, time elapsed from seeing the physician until discharge or admission to a ward. These findings suggest that LOS in ED is mainly affected by organizational and modifiable factors. Enhancing the laboratory and diagnostic imaging results time, timely consultations, decision making, and employing cost-effective interventions to enhance patients flow in ED may reduce proportion of patients breaching the LOS target.