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

Kyung-Shin Lee; Hye Sook Min; Jae Young Moon; Daesung Lim; Younghwan Kim; Eunsil Ko; You Sun Kim; Joohae Kim; Jeehye Lee; Ho Kyung Sung

doi:10.1186/s12873-022-00745-y

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

BMC Emerg Med. 2022 Nov 21;22(1):183. doi: 10.1186/s12873-022-00745-y.

Authors

Kyung-Shin Lee¹, Hye Sook Min¹, Jae Young Moon^{2

3}, Daesung Lim⁴, Younghwan Kim⁵, Eunsil Ko⁶, You Sun Kim⁷, Joohae Kim⁸, Jeehye Lee⁶, Ho Kyung Sung^{9

10}

Affiliations

¹ Public Health Research Institute, National Medical Center, 245 Eulgi-Ro, Jung-Gu, Seoul, 04564, Korea.
² Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea.
³ Department of Pulmonary and Critical Care Medicine, Chungnam National University Sejong Hospital, Sejong, Korea.
⁴ Department of Emergency Medicine, Seoul Medical Center, Seoul, Korea.
⁵ Department of Trauma Surgery, National Medical Center, Seoul, Korea.
⁶ National Emergency Medical Center, National Medical Center, Seoul, Korea.
⁷ Department of Pediatrics, National Medical Center, Seoul, Korea.
⁸ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Medical Center, Seoul, Korea.
⁹ Public Health Research Institute, National Medical Center, 245 Eulgi-Ro, Jung-Gu, Seoul, 04564, Korea. hokyungsung@nmc.or.kr.
¹⁰ National Emergency Medical Center, National Medical Center, Seoul, Korea. hokyungsung@nmc.or.kr.

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.

Keywords: Critical care; Emergency department; In-hospital mortality; Intensive care unit; Length of stay.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Emergency Service, Hospital*
Hospital Mortality
Hospitals*
Humans
Length of Stay
Retrospective Studies