TY - JOUR
T1 - Longer time to transfer from the emergency department after bed request is associated with worse outcomes
AU - Paton, Andrew
AU - Mitra, Biswadev
AU - Considine, Julie
PY - 2019/4
Y1 - 2019/4
N2 - Objective: To determine the relationships between: (i) total ED length of stay (EDLOS) and in-hospital mortality, ward clinical deterioration; and (ii) between time of bed request, ward transfer and in-hospital mortality, with a particular focus on patients transferred just prior to a 4 h EDLOS. Methods: Retrospective cohort study using data from three acute care hospitals in Melbourne, Australia. Adult patients admitted from the ED to a non-monitored ward within 8 h. Patients were sub-grouped by EDLOS; EDLOS 3.5–4 h compared to 0–3.5 h and 4–8 h. In-hospital mortality, number of medical emergency team (MET)/cardiac arrest team (CAT) events. Results: A total of 24 746 patients were included: 4396 patients with EDLOS <210 min; 4090 patients with EDLOS of 210–240 min; and 16 260 patients with EDLOS >240 min. Mortality overall was 2.2% (n = 545), highest mortality was seen with EDLOS >4 h (2.4%, n = 399) and lowest in patients with EDLOS 3.5–4 h (1.5%, n = 63, OR 0.67 [95% CI: 0.47–0.93, P = 0.02]). Time from bed request to transfer of >240 min was associated with increased odds of death at hospital discharge (adjusted OR 1.39 [95% CI: 1.08–1.78]). There was no difference in rate of MET calls within 24 h between groups (3.5–4 h = 64 [1.5%], <3.5 h = 60 [1.5%], 4–8 h = 235 [1.4%]). Conclusions: Both shorter time in ED and shorter time between bed request and ward transfer were independently associated with improved outcomes. Whole of hospital measures to reduce length of stay in the ED should focus on shorter ward transfer times after bed request.
AB - Objective: To determine the relationships between: (i) total ED length of stay (EDLOS) and in-hospital mortality, ward clinical deterioration; and (ii) between time of bed request, ward transfer and in-hospital mortality, with a particular focus on patients transferred just prior to a 4 h EDLOS. Methods: Retrospective cohort study using data from three acute care hospitals in Melbourne, Australia. Adult patients admitted from the ED to a non-monitored ward within 8 h. Patients were sub-grouped by EDLOS; EDLOS 3.5–4 h compared to 0–3.5 h and 4–8 h. In-hospital mortality, number of medical emergency team (MET)/cardiac arrest team (CAT) events. Results: A total of 24 746 patients were included: 4396 patients with EDLOS <210 min; 4090 patients with EDLOS of 210–240 min; and 16 260 patients with EDLOS >240 min. Mortality overall was 2.2% (n = 545), highest mortality was seen with EDLOS >4 h (2.4%, n = 399) and lowest in patients with EDLOS 3.5–4 h (1.5%, n = 63, OR 0.67 [95% CI: 0.47–0.93, P = 0.02]). Time from bed request to transfer of >240 min was associated with increased odds of death at hospital discharge (adjusted OR 1.39 [95% CI: 1.08–1.78]). There was no difference in rate of MET calls within 24 h between groups (3.5–4 h = 64 [1.5%], <3.5 h = 60 [1.5%], 4–8 h = 235 [1.4%]). Conclusions: Both shorter time in ED and shorter time between bed request and ward transfer were independently associated with improved outcomes. Whole of hospital measures to reduce length of stay in the ED should focus on shorter ward transfer times after bed request.
KW - 4 h rule
KW - death/mortality
KW - EDLOS
KW - emergency department operations
KW - NEAT
UR - http://www.scopus.com/inward/record.url?scp=85053026253&partnerID=8YFLogxK
U2 - 10.1111/1742-6723.13120
DO - 10.1111/1742-6723.13120
M3 - Article
AN - SCOPUS:85053026253
VL - 31
SP - 211
EP - 215
JO - Emergency Medicine Australasia
JF - Emergency Medicine Australasia
SN - 1742-6731
IS - 2
ER -