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Factors affecting length of stay in the pediatric emergency department
Sung-Tse Li1, Nan-Chang Chiu, Wen-Chuan Kung
1Department of Pediatrics, Hsinchu Mackay Memorial Hospital, Hsinchu, Taiwan. a4521@ms7.mmh.org.tw
Insights
This study analyzed pediatric emergency department (ED) length of stay (LOS), finding that shorter waiting times for admission and fewer laboratory tests significantly reduce patient LOS.
Area of Science:
- Pediatric Emergency Medicine
- Healthcare Operations Research
Background:
- Emergency department (ED) overcrowding is a significant issue, leading to prolonged length of stay (LOS).
- Understanding factors influencing LOS in pediatric EDs is crucial for improving patient flow and care quality.
Purpose of the Study:
- To identify and analyze key factors affecting the length of stay (LOS) for patients in a pediatric emergency department (ED).
Main Methods:
- Retrospective analysis of 29,035 patient visits to a pediatric ED from July 2006 to June 2007.
- Utilized eta-squared correlation ratio and Cramer's V test to assess variable associations.
- Employed a classification and regression tree (CART) model for analysis, with data split into training (two-thirds) and validation (one-third) sets.
Main Results:
- Fever was the primary reason for visits (61.1%).
- The mean LOS was 2.6 ± 4.67 hours, with 74.3% of visits under 2 hours.
- CART analysis identified five key factors influencing LOS, creating nine distinct patient subgroups.
Conclusions:
- Shortest LOS was associated with waiting less than 8 hours for hospitalization, no admission, no laboratory tests, door-to-physician time under 60 minutes, and absence of gastrointestinal symptoms.
- Patients waiting over 16 hours for hospitalization experienced the longest LOS.
Background:
A large volume of visits can cause an emergency department (ED) to become overcrowded, resulting in a longer length of stay (LOS). The objective of this study was to analyze factors affecting the LOS in the pediatric ED.
Methods:
Records of all visits to the pediatric ED of the study hospital, from July 1, 2006 to June 31, 2007, were retrospectively retrieved. Data were collected from the hospital's computerized records system. Eta-squared correlation ratio and Cramer's V test evaluated the associations between variables. Two-thirds of the database was randomized for the classification and regression tree (CART) model-building dataset, and one-third was used for the validation dataset.
Results:
A total of 29,035 patients visited the pediatric ED during the evaluation period. Of the total visits, 61.1% were due to complaints of fever. The mean LOS was 2.6 ± 4.67 hours, and 74.3% of visits had an LOS of shorter than 2 hours. The CART analysis selected five factors (waiting time for hospitalization, laboratory tests, door-to-physician time, gastrointestinal symptoms, and patient outcome) to produce a total of nine subgroups of patients. The mean LOS of the model-building dataset closely correlated with that of the validation dataset (r(2) = 0.999).
Conclusion:
Patients who were waiting for hospitalization for less than 8 hours or were not admitted, those without any laboratory tests, those having door-to-physician time less than 60 minutes, and those without any gastrointestinal symptoms had the shortest LOS. Patients who waited for hospitalization for more than 16 hours had the longest LOS.
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