Patient and organizational characteristics predict a long length of stay in the emergency department – a Swedish cohort study

Background: Emergency departments (EDs) constitute a central part of the healthcare system that receives patients with complaints of varied urgency. A long length of stay (LOS) in the ED is associated with crowding, low patient satisfaction and poor patient outcomes. Therefore, it is important to understand the key drivers and patient characteristics associated with long LOS. Aims: To identify patient-related and organization-related characteristics associated with the longest ED LOS. Methods: All adult visits (n=19 503) to the ED at Karolinska University Hospital in Solna, Sweden, between 8 a.m. and 9 p.m. during 2012 were divided into quartiles on the basis of their LOS. The quartile with the longest LOS (n=4876) was compared with the two intermediate quartiles (n=9752) and the shortest quartile (n=4875). Differences in patient and organizational characteristics were assessed using multivariate logistic regression models to achieve odds ratios (ORs) with 95% confidence intervals (CIs). Results: The patient-related factors associated with long LOS were female sex (OR 1.22, 95% CI 1.14–1.30), age 65–79 (OR 1.82, 95% CI 1.67–1.97), age 80 or older (OR 2.76, 95% CI 2.52–3.02) and the chief complaint of dyspnoea (OR 1.55, 95% CI 1.39–1.73). Conclusion: Long LOS in the ED is associated with both patient and organizational characteristics and the elderly are at particular risk of long LOS. These insights may be used to improve patient outcome metrics and enhance ED efficiency. Further studies are needed to clarify the role of additional factors as well as the causality of the studied factors.

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