Association between emergency department length of stay and outcome of patients admitted either to a ward, intensive care or high dependency unit.

OBJECTIVE: To evaluate the association of ED length of stay (EDLOS) and outcome of patients admitted to a ward, intensive care (ICU) or stepdown (high dependency) unit (SDU). DESIGN: Retrospective cohort study using linked administrative and clinical data. SETTING: 650-bed, university-affiliated, tertiary referral hospital, whose ED has approximately 60 000 patient presentations per annum. PARTICIPANTS: Adult patients admitted via the ED, to a ward (ED to ward), ICU (ED to ICU) or SDU (ED to SDU), and whose EDLOS was <24 h. OUTCOME MEASURES: Hospital outcome and LOS. RESULTS: A total of 43 484 patients over 4 years. Median EDLOS was 2:36 h for ICU, 5:07 h for SDU and 7:19 h for ward (P < 0.01) patients. EDLOS differed significantly, based on hospital outcome, for ward (alive, 7:18 h vs died, 7:44 h, P < 0.001), but not SDU or ICU patients. At an EDLOS of 4 and 8 h, 19.4% and 5.2% of ICU, 52.1% and 15.5% of SDU and 77.9% and 32.6% of ward patients remained in the ED. EDLOS was not a significant predictor of death, in comparison with increasing age and admitting unit across all three groups, and higher triage acuity for ED to ward and ED to ICU. CONCLUSIONS: EDLOS was greater for ED to ward patients, and of the ED to ward patients who died. At an EDLOS of 4 h there were fewer ICU, in comparison with ward, patients remaining in the ED. Future studies that report on EDLOS should differentiate for patients admitted from the ED to the ward, ICU or SDU.

Direct and delayed admission to an intensive care or high dependency unit following discharge from the emergency department: associated patient characteristics and hospital outcomes.

OBJECTIVE: To compare patients admitted from the emergency department (ED) directly to a ward (EDWard), the intensive care unit (EDICU) or stepdown (high dependency) unit (EDSDU) with patients admitted via the ED, but whose admission to an ICU (EDWardICU) or SDU (EDWardSDU) was preceded by a ward stay. DESIGN, SETTING AND PARTICIPANTS: Administrative and clinical data linkage; 650-bed, tertiary referral hospital, whose ED has about 60 000 patient presentations per annum; adult patients admitted via the ED to a ward, ICU or SDU and whose ED length of stay (LOS) was < 24 h. MAIN OUTCOME MEASURE: Hospital outcome and stay. RESULTS: From January 2004 to December 2007, there were 43 484 patients, of whom 40 609 (93.4%) were EDWard, 1020 (2.3%) were EDICU, 873 (2.0%) were EDSDU, 503 (1.2%) were EDWardSDU, and 479 (1.1%) were EDWardICU. Hospital mortality for EDWardICU patients exceeded that of EDICU patients (34.9% v 23.3%; P < 0.01), as did EDWardSDU exceed EDSDU (12.3% v 7.8%; P < 0.01). Median ward stay for EDWardICU patients was 47 h 37 min (IQR, 14 h 48 min - 131 h 53 min) and for EDWardSDU patients, 46 h 18min (IQR, 18h 28 min - 140h 12 min) (P=0.75). Compared with patients admitted to the ICU from the operating theatre, EDWardICU patients had a longer median ward stay (58 h 35 min v 34 h 36 min; P = 0.03) and hospital mortality (42.8% v 20.2%; P < 0.01). CONCLUSION: Patients discharged from the ED to a general ward and subsequently to an ICU or SDU had a mortality that exceeded that of ED patients admitted directly to the ICU or SDU. Further investigations are warranted to explain this excess mortality and ascertain the extent of potential preventability.