The Association between Emergency Department Length of Stay and In-Hospital Mortality in Older Patients Using Machine...

Area of Science:

• Geriatric Medicine
• Emergency Medicine
• Health Services Research

Background:

• The relationship between emergency department length of stay (EDLOS) and in-hospital mortality (IHM) in elderly patients is not well understood.
• Older patients represent a growing demographic with unique healthcare needs.
• Understanding factors influencing mortality in this population is crucial for improving care quality.

Purpose of the Study:

• To investigate the association between EDLOS and IHM in older patients.
• To explore the correlation between boarding time (BT) and IHM in this demographic.
• To identify specific EDLOS and BT patterns associated with increased mortality risk.

Main Methods:

• Retrospective analysis of 78,478 older patients (≥60 years) from an urban academic tertiary care center (2010-2016).
• Stratification into age subgroups: 60-74, 75-89, and ≥90 years.
• Application of machine learning models (Light Gradient Boosting Machine) to assess EDLOS and BT correlations with IHM.

Main Results:

• In-hospital mortality incidence increased with age: 2.7% (60-74), 4.5% (75-89), and 6.3% (≥90 years).
• EDLOS and BT were statistically correlated with IHM (p < 0.001).
• A significantly higher risk of IHM was observed with short EDLOS (≤1 hour) and long BT, alongside higher quality assurance issue rates.

Conclusions:

• Short EDLOS coupled with prolonged BT poses a significantly higher risk of in-hospital mortality in older patients.
• Quality assurance issues were more prevalent in patients with shorter EDLOS.
• Consideration of dedicated care areas and teams for older patients in the ED is recommended for policymakers.