Length of stay in the hospital emergency department

In light of the growing emphasis on meeting hospital emergency department (ED) quality measures, healthcare providers are faced with the challenge of identifying ways to reduce ED length of stay and wait times. Similarly, an emphasis on cost reduction has placed additional pressures on providers to improve timeliness of treatment and improve ED throughput. Studies examining key factors contributing to ED length of stay are critical to identifying how these challenges can be met.

It is well known among healthcare professionals that the ability to provide timely and appropriate treatment to patients in the ED depends on being able to obtain rapid and accurate diagnostic test results ^1–4. The health economics and analytics team at Boston Strategic Partners recently worked with Ryan Tuttle, Global Marketing Director, BD Preanalytical Systems and the BD Health Economics & Outcomes Research team to examine the relationship between laboratory test turnaround time and patient length of stay in the ED. Working closely with the BD team, we conducted a retrospective analysis of patient data from an electronic health record (EHR) database that aggregates de-identified clinical, administrative, pharmacy, and laboratory data from nearly 500 US healthcare facilities. This data source provides insight into real-world practices and outcomes in a large number of patients treated in a variety of facilities across the country.

With the goal of examining a patient population for which length of ED stay would likely reflect laboratory testing dynamics, the analysis was limited to patients who spent less than 7 hours in the ED and were subsequently discharged to home (a “treat and release” population). Focusing on ED admissions between January 1, 2012 and December 31, 2012, our analysis included more than 463,000 unique patient encounters and revealed a significant relationship between laboratory test turnaround time and ED length of stay. In this patient population, a 10-minute reduction in test turnaround time was associated with a nearly 7-minute reduction in length of stay in the ED.

There are two key implications of these findings. The first is that developing and measuring shared turnaround time metrics between the ED and laboratory presents an important opportunity to help reduce ED length of stay. The second is that implementation of processes or technologies that improve laboratory test turnaround time may help to support reductions in ED length of stay, and adoption of these processes/technologies should be examined at both the laboratory and hospital level.

While length of stay in the ED is certainly driven by a wide array of factors, our study sheds light on a key variable in this equation – and one that presents an opportunity to better track and potentially improve overall length of stay. Does your laboratory work with the ED to track turnaround times and length of stay? Are there processes or available technologies that would support shorter test turnaround times in your laboratory? Answering these question may help to identify potential routes to improving ED length of stay.

1. Montalescot G, Borentain M, Payot L, Collet JP, Thomas D. Early vs late administration of glycoprotein IIb/IIIa inhibitors in primary percutaneous coronary intervention of acute ST-segment elevation myocardial infarction: a meta-analysis. JAMA. 2004;292(3):362-6.
2. Vacek JL. Classic Q wave myocardial infarction. Aggressive, early intervention has dramatic results. Postgrad Med. 2002;112(1):71-7.
3. Bonner AB, Monroe KW, Talley LI, Klasner AE, Kimberlin DW. Impact of the rapid diagnosis of influenza on physician decision-making and patient management in the pediatric emergency department: results of a randomized, prospective, controlled trial. Pediatrics. 2003;112(2):363-7.
4. Than M, Aldous S, Lord SJ, et al. A 2-hour diagnostic protocol for possible cardiac chest pain in the emergency department: a randomized clinical trial. JAMA Intern Med. 2014;174(1):51-8.