Risk Factors for Hospital Admissions Among Emergency Department Patients: From Triage to Admission

Area of Science:

• Emergency Medicine
• Health Services Research
• Hospital Administration

Background:

• Emergency departments (EDs) are primary access points for acute inpatient care.
• EDs face significant demand and supply challenges impacting patient flow and resource allocation.

Purpose of the Study:

• To identify factors associated with hospital admissions among patients presenting to a Singapore tertiary-care ED.
• To analyze the influence of patient demographics, clinical factors, and ED operational status on admission decisions.

Main Methods:

• Retrospective cohort study of ED visits in Singapore from January 1 to December 31, 2019.
• Multivariable, mixed-effect logistic regression model incorporating patient demographics, triage category, arrival mode, referral source, visit time, diagnosis, and ED occupancy.

Main Results:

• Over 29% of 141,719 ED visits resulted in hospital admission.
• Key factors for increased admission odds include higher patient acuity (OR 326), older age (70+ vs 30-, OR 13.8), male gender, specific ethnicities, ambulance transport, and non-self-referral.
• ED crowding showed a marginal association with hospital admissions.

Conclusions:

• Patient acuity and age are the most significant predictors of hospital admission from the ED.
• Emergency physician admission decisions are largely consistent and minimally affected by ED crowding.
• Findings provide insights for policy development and interventions to manage inpatient bed demand.