ปัจจัยที่มีความสัมพันธ์กับระยะเวลาที่ผู้ป่วยอยู่ในแผนกฉุกเฉินนานมากกว่า 6 ชั่วโมง

Korakot Plongthong; Boriboon Chenthanakij; Borwon Wittayachamnankul; Parinya Tianwibool; Phichayut Phinyo; Theerapon Tangsuwanaruk

Authors

Korakot Plongthong Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University
Boriboon Chenthanakij Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University
Borwon Wittayachamnankul Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University
Parinya Tianwibool Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University
Phichayut Phinyo Department of Family Medicine, Faculty of Medicine, Chiang Mai University
Theerapon Tangsuwanaruk Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University

Keywords:

emergency department, hospital administration, length of stay

Abstract

Background & Rationale: Extended length of stay (LOS) in the emergency department (ED) affects LOS in hospital, increased mortality and increased hospital resource uses. Knowing factors affecting extended ED LOS should lead to improved patient’s quality of care. Methodology: The study design was a retrospective analytical study in ED at Maharaj Nakorn Chiang Mai Hospital between January 2018 to June 2019 by collecting data from the electronic medical records. Data collection included factors expected to extend ED LOS 6 hours and longer by using multivariable logistics regression. Result: A total of 330 patients of whom 165 with ED LOS ≥ 6 hours were eligible. The risk factor for staying 6 hours and longer in the ED was having urine investigation (adjusted odds ratio [aOR] 3.43, 95% CI 2.05-5.73, p < 0.01). Moreover, patients in the evening and night shifts observed a shorter ED LOS compared to the day shift (aOR 0.26, 95% CI 0.15-0.47, p < 0.01 and aOR 0.40, 95% CI 0.21-0.77, p < 0.01, respectively). For patient presentation to ED, the refer-in patients had a shorter ED LOS compared to the walk-in patients (aOR 0.33, 95% CI 0.15-0.70, p < 0.01). Conclusion: The factors extending ED LOS ≥ 6 hours included urine investigation process and the day shift. Refer-in patients were likely to have a shortened ED LOS.

References

Forero R, Hillman KM, McCarthy S, Fatovich DM, Joseph AP, Richardson R. Access block and ED overcrowding. Emerg Med Australas 2010 Apr;22(2):119-35.

Wickman L, Svensson P, Djärv T. Effect of crowding on length of stay for common chief complaints in the emergency department: A STROBE cohort study. Medicine (Baltimore) 2017 Nov 1;96:e8457.

Singer AJ, Thode HC, Viccellio P, Pines JM. The association between length of emergency department boarding and mortality. Acad Emerg Med 2011 Dec;18(12):1324-9.

Mortimore A, Cooper S. The “4-hour target”: emergency nurses’ views. Emerg Med J 2007 Jun;24(6):402-4.

Liew D, Liew D, Kennedy MP. Emergency department length of stay independently predicts excess inpatient length of stay. Med J Aust 2003 Nov 17;179(10):524-6.

Sullivan C, Staib A, Khanna S, Good NM, Boyle J, Cattell R, et al. The National Emergency Access Target (NEAT) and the 4-hour rule: time to review the target. Med J Aust 2016 May;204(9):354.

Tenbensel T, Chalmers L, Jones P, Appleton-Dyer S, Walton L, Ameratunga S. New Zealand’s emergency department target - did it reduce ED length of stay, and if so, how and when? BMC Health Serv Res 2017 Sep 26;17(1):678.

Driesen BEJM, van Riet BHG, Verkerk L, Bonjer HJ, Merten H, Nanayakkara PWB. Long length of stay at the emergency department is mostly caused by organisational factors outside the influence of the emergency department: a root cause analysis. PLoS One 2018;13(9):e0202751.

Ienghong K. Factors affecting length of stay more than 4 hours in the emergency department of Srinagarind Hospital. Srinagarind Med J 2014;29(1):7-13. (in Thai)

Imsuwan A, Imsuwan I. Factor associated with length of stay more than 4 hours at the emergency department of Thammasat University Hospital. Thammasat Med J 2015 Mar;15(1):39-49 (in Thai)

Downing A, Wilson RC, Cooke MW. Which patients spend more than 4 hours in the accident and emergency department? J Public Health 2004 Jun 1;26(2):172-6.