Badheeb Ahmed M, Almutairi Mohammed A, Almakrami Abbas H, Aman Abdelaziz A, Al-Swedan Ali Dhafer, Alrajjal Khalil, Seada Islam A, Abu Bakar Abdullah, Alkarak Samer, Ahmed Faisal, Babiker Awadalla, Susheer Sindhu, Badheeb Mohamed, Almutairi Mofeed, Obied Hamoud Y
Oncology, King Khalid Hospital-Oncology Center, Najran, SAU.
Internal Medicine, King Khalid Hospital, Najran, SAU.
Cureus. 2024 Jul 16;16(7):e64684. doi: 10.7759/cureus.64684. eCollection 2024 Jul.
Reducing the frequency of emergency department (ED) patient visits for treatment, particularly in urgent instances, is a global healthcare objective. Additionally, a more extended stay in the ED can harm a patient's prognosis during later hospitalization. This study aims to investigate the factors affecting the length of stay in the ED in a teaching hospital.
A retrospective chart review study was done between January 1, 2021, and February 31, 2021, involving 122 adult patients who had delayed ED visits to King Khalid Hospital in Najran, Saudi Arabia. Data on the patient's characteristics, visit time, and the causes for the delay based on the Canadian Triage and Acuity Scale (CTAS) were gathered and analyzed. Factors associated with more than six hours of delay were investigated in a univariate analysis.
The mean age was 52.3 ±13.5 years, and 42 (34.4%) were more than 65 years of age. More than half of the study population were female (n=66; 54.1%). Most delays occurred among CTAS 4 and 5 cases (47.5%), and 22 (18.0%) occurred during holidays. The mean delay time was 6.1 ±1.8 hours. The leading delay causes were multiple consultations with further investigations (37.7%) and conflict between the teams (36.1%). In univariate analysis, ED visiting at holiday time (OR: 0.14; 95% CI: 0.04-0.40, p <0.001) and CTAS 4 and 5 (OR: 2.22; 95% CI: 0.95-5.30, p = 0.003) significantly had more delay. Factors associated with delay in univariate analysis were multiple consultations with further investigations (OR: 2.82; 95% CI: 1.32-6.26, p = 0.013), various assessments in different ED areas with a late arrival of the specialist (OR: 0.43; 95% CI: 0.20-0.91, p = 0.042), and conflict between the teams (OR: 2.50; 95% CI: 1.17-5.54, p = 0.031).
In this study, multiple assessments in different ED areas and conflict between the teams were the main factors that caused delays in ED. Implementing a timeframe monitoring system for consultations while emphasizing accelerated decision-making and disposition for patients and understanding teamwork collaboration may reduce patients' length of stay in the ED. Implementing these strategies and evaluating their impact on the length of stay in the ED requires further investigation.
降低急诊科患者就诊频率，尤其是在紧急情况下，是全球医疗保健的目标。此外，在急诊科停留时间过长会对患者后期住院的预后产生不利影响。本研究旨在调查影响某教学医院急诊科住院时间的因素。
于2021年1月1日至2021年2月31日进行了一项回顾性病历审查研究，纳入了122例延迟前往沙特阿拉伯纳季兰哈立德国王医院急诊科就诊的成年患者。收集并分析了患者特征、就诊时间以及基于加拿大分诊和 acuity 量表（CTAS）的延迟原因数据。在单因素分析中调查了与延迟超过6小时相关的因素。
平均年龄为52.3±13.5岁，42例（34.4%）年龄超过65岁。超过一半的研究人群为女性（n = 66；54.1%）。大多数延迟发生在CTAS 4级和5级病例中（47.5%），22例（18.0%）发生在节假日期间。平均延迟时间为6.1±1.8小时。主要延迟原因是多次会诊及进一步检查（37.7%）和团队之间的冲突（36.1%）。在单因素分析中，节假日就诊（OR：0.14；95%CI：0.04 - 0.40，p <0.001）和CTAS 4级和5级（OR：2.22；95%CI：0.95 - 5.30，p = 0.003）显著延迟更多。单因素分析中与延迟相关的因素包括多次会诊及进一步检查（OR：2.82；95%CI：1.32 - 6.26，p = 0.013）、在不同急诊科区域进行各种评估且专家迟到（OR：0.43；95%CI：0.20 - 0.91，p = 0.042）以及团队之间的冲突（OR：2.50；95%CI：1.17 - 5.54，p = 0.031）。
在本研究中，在不同急诊科区域进行多次评估以及团队之间的冲突是导致急诊科延迟的主要因素。实施会诊时间框架监测系统，同时强调加快患者的决策制定和处置，并理解团队协作，可能会减少患者在急诊科的住院时间。实施这些策略并评估其对急诊科住院时间的影响需要进一步研究。
