Type of facility influences lengths of stay of children presenting to high volume emergency departments

Abstract

Background: Emergency department crowding may impact patient and provider outcomes. We describe emergency department crowding metrics based on presentations by children to different categories of high volume emergency departments in Alberta, Canada.

Methods: This population-based retrospective study extracted all presentations made by children (age < 18 years) during April 2010 to March 2015 to 15 high volume emergency departments: five regional, eight urban, and two academic/teaching. Time to physician initial assessment, and length of stay for discharges and admissions were calculated based on the start of presentation and emergency department facility. Multiple metrics, including the medians for hourly, facility-specific time to physician initial assessment and length of stay were obtained.

Results: About half (51.2%) of the 1,124,119 presentations were made to the two academic/teaching emergency departments. Males presented more than females (53.6% vs 46.4%) and the median age was 5 years. Pediatric presentations to the three categories of emergency departments had mostly similar characteristics; however, urban and academic/teaching emergency departments had more severe triage scores and academic/teaching emergency departments had higher admissions. Across all emergency departments, the medians of the metrics for time to physician initial assessment, length of stay for discharges and for admission were 1h11min, 2h21min, and 6h29min, respectively. Generally, regional hospitals had shorter times than urban and academic/teaching hospitals.

Conclusions: Pediatric presentations to high volume emergency departments in this province suggest similar delays to see providers; however, length of stay for discharges and admissions were shorter in regional emergency departments. Crowding is more common in urban and especially academic emergency departments and the impact of crowding on patient outcomes requires further study.

Keywords: Administrative data; Emergency department; Length of stay; Time to physician initial assessment; Wait times.

Fig. 1

Emergency department presentations by fiscal year and ED category: regional (○), urban (+), and academic/teaching (×)

Fig. 2

Median and interquartile range (25th percentile, 75th percentile) for hourly, facility-specific median physician initial assessment (PIA-M) times, median length of stay (LOS-M) for discharged patients, and median length of stay (LOS-M) for admitted patients for all EDs and by ED category