Association Between the Emergency Department Length of Stay and in-Hospital Mortality: A Retrospective Cohort Study

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Purpose: The number of emergency department (ED) visits and prolonged ED length of stay (LOS) are increasing worldwide. Prolonged ED LOS may be associated with a higher risk of in-hospital mortality. Here, we analysed the association between of ED LOS and the risk of in-hospital mortality in a hospital in Jakarta, Indonesia. Patients and methods: This was a single-centre retrospective cohort study performed in a referral academic hospital in Jakarta, Indonesia. Data on ED visits in 2019 were obtained from the electronic medical records. ED patient was used as the unit of the analysis. The dependent variable was all-cause in-hospital mortality during one’s visit. The main independent variable was ED LOS with respect to approval (< 8 h) and prolonged (≥ 8 h). Potential confounders were sex, age, triage categories, trauma-related case, malignancy-related case, labour-related case, and referral patients from other healthcare facilities. Multivariate logistic regression analysis was performed to evaluate the association of ED LOS and in-hospital mortality after adjusting for other confounders. Results: There were 18,553 participants included in the analysis. The in-hospital mortality was 13.5% among all participants, and 63.5% participants had an ED LOS ≥ 8 h. Multivariate analysis showed that a prolonged ED LOS was associated with an increased risk of in-hospital mortality (adjusted relative risk, 2.69; 95% confidence interval, 2.40– 3.03; P < 0.001). Conclusion: Prolonged ED LOS was associated with risk an increased of in-hospital mortality after adjusting for several confounders. In future, hospital service plans should aim to reduce ED LOS and increase patient flow from the ED to in-patient wards. Plain Language Summary: Prolonged emergency department length of stay (ED LOS) was associated with risk of in-hospital mortality in an Indonesia referral hospital; this is the first such reported association. Therefore, reduced ED LOS and increased patient flow to the inpatient ward should be a target for quality improvement in hospital service plans. Keywords: emergency department, mortality, length of stay, overcrowding, patient flow, triage

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