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Significant changes in emergency department length of stay and case mix over eight years at a large Swedish University Hospital
Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.ORCID iD: 0000-0002-3964-196X
Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
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2019 (English)In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 43, p. 50-55Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Describe the longitudinal development of crowding and patient/emergency department (ED) characteristics at a Swedish University Hospital.

METHODS: A retrospective longitudinal registry study based on all ED visits with adult patients during 2009-2016 (N = 1,063,806). Patient characteristics and measures of ED crowding (ED occupancy ratio, length-of-stay [LOS], patients/clinician's ratios) were extracted from the hospital's electronic health record. Non-parametric analyses were conducted.

RESULTS: The proportion of unstable patients (triage level 1-2) increased while the proportion of admitted patients decreased. All crowding variables were stable, except for LOS, which increased by 9 min/visit/year (95% CI: 8.8-9.1). LOS for visits by patients ≥ 80 years increased more compared to those 18-79 (248 min vs. 190 min, p < 0.001). Unstable patients increased their median LOS compared to stable patients (triage level 3-5). LOS for discharged patients increased with an average of 7.7 min/year (95% CI: 7.5-7.9) compared to 15.5 min/year (95% CI: 15.2-15.8) for those being admitted.

CONCLUSION: Fewer admissions, despite an increase of unstable patients, is likely related to lack of in-hospital beds and contributes to ED crowding. The increase in median ED LOS, especially for patients in the subgroups unstable, ≥80 years and admitted to in-hospital care reflects this problem.

Place, publisher, year, edition, pages
2019. Vol. 43, p. 50-55
Keywords [en]
Clinicians, Crowding, Emergency department, Health policy, Patient safety, Physician, Quantitative, Registered nurse, Work environment
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
URN: urn:nbn:se:du-28476DOI: 10.1016/j.ienj.2018.08.001ISI: 000460680600009PubMedID: 30190224Scopus ID: 2-s2.0-85052831113OAI: oai:DiVA.org:du-28476DiVA, id: diva2:1247176
Available from: 2018-09-11 Created: 2018-09-11 Last updated: 2019-03-28Bibliographically approved

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Ehrenberg, AnnaFlorin, Jan

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