Prolonged Emergency Department Stay, Specialist-visit Delay, and Disposition-decision Delay as System-level Risks for...

Area of Science:

• Emergency Medicine
• Critical Care
• Public Health

Background:

• Prolonged emergency department (ED) boarding is a critical patient safety issue.
• It can delay essential interventions for sepsis patients.
• Understanding factors contributing to mortality in sepsis is crucial for improving outcomes.

Purpose of the Study:

• To investigate the association between total ED length of stay (ED-LOS) and 30-day mortality in adult sepsis patients.
• To evaluate the impact of delays in specialist visits and disposition decisions on sepsis mortality.

Main Methods:

• Retrospective observational cohort study of adult sepsis patients in a tertiary hospital.
• Primary exposure: total ED-LOS. Secondary exposures: time to specialist visit and disposition decision.
• Outcome: 30-day in-hospital mortality. Analysis: Multivariable logistic regression.

Main Results:

• 19.5% of 868 sepsis patients died within 30 days.
• Total ED-LOS was not significantly associated with 30-day mortality.
• Delays in specialist visits (aOR: 0.84) and disposition decisions (aOR: 0.94) were independently associated with increased mortality risk.

Conclusions:

• Total ED length of stay alone is not an independent predictor of sepsis mortality.
• Delays in specialist consultations and disposition decisions represent significant patient safety targets.
• Improving care transitions is vital for enhancing sepsis patient outcomes.