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

Prolonged emergency department (ED) boarding is a patient-safety concern that may delay time-critical interventions in sepsis. This study evaluated whether total ED length of stay (ED-LOS) and delays in specialist visit and disposition decisions were associated with 30-day mortality among adult patients with sepsis.

This retrospective observational cohort study included adults (≥18 y) presenting to the ED of a tertiary hospital in Northern Thailand between January 2019 and July 2024 with sepsis or septic shock. The primary exposure was total ED-LOS (hours), analyzed both as a continuous and a categorical variable. Secondary time intervals included door-to-fluid, door-to-antibiotic, door-to-vasopressor, specialist visit, and disposition decision times. The primary outcome was in-hospital 30-day mortality. Multivariable logistic regression adjusted for age, sex, illness severity (NEWS, MEDS, lactate), and treatment variables.

Among 868 patients, 19.5% died within 30 days. Median ED-LOS was 7.0 hours (IQR: 5.0-10.3) with no difference between survivors and nonsurvivors (P=0.65). In adjusted analyses, total ED-LOS was not associated with 30-day mortality (aOR: 0.99, 95% CI: 0.97-1.02, P=0.61). However, delays in specialist visits (per 1 h increase; aOR: 0.84, 95% CI: 0.76-0.92, P<0.001) and disposition decisions (per 1 h increase; aOR: 0.94, 95% CI: 0.90-0.98, P=0.001) were independently associated with higher mortality.

Total ED-LOS alone was not independently associated with mortality. Delays in specialist visits and disposition decisions were associated with increased mortality risk, highlighting care transitions as potential patient-safety targets in sepsis management.