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Emergency department length of stay for critical care admissions: a population-based study


Rationale — Emergency department (ED) crowding is common; results in prolonged ED length of stay (LOS), and may worsen outcomes for critically ill patients.

Objectives — To describe patient, institutional and ED level variables associated with prolonged ED LOS for patients admitted from ED to the intensive care unit (ICU).

Methods — Population-based cohort study in Ontario, Canada of adults admitted to ICU from ED, excluding inter-hospital transfers and scheduled visits. Regression modelling examined associations between patient/centre-level variables and ED LOS >6 hours and on 90-day mortality.

Measurements and Main Results — From April 2007 to March 2012, 261,274 adults presented to 118 EDs with 314,836 ICU admissions, representing 4.1% of all adult ED visits (incidence 1,374 ICU admissions/100,000 ED visits). Median (IQR) ED LOS was 7 (4-13) hours. Less than half (41.4%, 95%CI 41.2-41.5) had ED LOS ≤6 hours; 10.5% (95%CI 10.4-10.6) stayed ≥24 hours. Centre level variables associated with ED LOS >6 hours included shift-level ED crowding (mean LOS of patients of similar acuity registering in same 8 hours) (OR 1.19/hour, 95%CI 1.19-1.19), ED annual volume (OR 1.01/1000 patients, 95%CI 1.01-1.01), ED presentation 00:00-07:59 (OR 1.41, 95%CI 1.38-1.45), and ICU functioning at >20% above average annual census (OR 1.10, 95%CI 1.08-1.12). ED LOS >6 hours was not associated with 90-day mortality after adjustment (OR 0.99, 95%CI 0.97-1.02).

Conclusions — Less than half of ICU patients had an ED LOS ≤6 hours, an internationally recognized performance indicator for ED care quality. ED and ICU strain generated by time-varying demand on capacity were important determinants of ED LOS.



Rose L, Scales DC, Atzema C, Burns KE, Gray S, Doing C, Kiss A, Rubenfeld G, Lee JS. Ann Am Thorac Soc. 2016; 13(8):1324-32. Epub 2016 Apr 25.

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Contributing ICES Scientists