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KMID : 0385920220330010069
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Journal of the Korean Society of Emergency Medicine
2022 Volume.33 No. 1 p.69 ~ p.83
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Association between the emergency department length of stay and severity-standardized survival among severe emergency patients
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Kang Sa-Yul
Choi Yu-Ri
Lee Sung-Woo
Han Gap-su
Kim Su-Jin
Kim Won-Young
Kang Hyung-Goo
Hong Eun-Seog
Jeong Jin-Woo
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Abstract
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Objective: The length of stay in the emergency department (ED) is a major contributor to ED overcrowding, which in turn negatively affects the quality of emergency care. Several efforts have been made to reduce the ED length of stay (EDLOS), including a mandatory target to limit ED-LOS within certain parameters. However, the association between EDLOS and treatment results is yet to be clarified. The authors investigated the influence of ED-LOS on patient survival by comparing severity-adjusted survival.
Methods: This study was a retrospective analysis of data registered in 2018 in the National Emergency Department Information System (NEDIS). Cases registered by the regional and local emergency centers were included for analysis.
The standardized W scores (Ws) based on the Emergency Department Initial Evaluation Score were used to assess treatment outcomes represented by severity-standardized survival, and the correlation between the Ws and the ED-LOS was analyzed.
Results: A total of 2,281,526 cases were included for analysis. The overall mortality comprised 52,284 cases (2.3%) and the median ED-LOS was 165 minutes (interquartile range, 96-301). Although a longer ED-LOS was associated with poorer outcomes overall, the association was not apparent when an analysis of cases eligible for ED-LOS evaluation in the national evaluation program was carried out. Moreover, in the analysis of severe cases with a predicted survival probability of less than 0.9, an ED-LOS shorter than 6 hours was associated with significantly poorer severity-adjusted survival.
Conclusion: The study revealed that the current ED-LOS criteria used in the national evaluation program were not associated with better survival.
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KEYWORD
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Program evaluation, Quality improvement, Emergency service, hospital, Length of stay, Survival
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