Long length of stay at the emergency department is mostly caused by organisational factors outside the influence of the emergency department: A root cause analysis

Babiche E.J.M. Driesen, Bauke H.G. Van Riet, Lisa Verkerk, H. Jaap Bonjer, Hanneke Merten, Prabath W.B. Nanayakkara

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background Emergency department (ED) crowding is common and associated with increased costs and negative patient outcomes. The aim of this study was to conduct an in-depth analysis to identify the root causes of an ED length of stay (ED-LOS) of more than six hours. Methods An observational retrospective record review study was conducted to analyse the causes for ED-LOS of more than six hours during a one-week period in an academic hospital in the Netherlands. Basic administrative data were collected for all visiting patients. A root cause analysis was conducted using the PRISMA-method for patients with an ED-LOS > 6 hours, excluding children and critical care room presentations. Results 568 patients visited the ED during the selected week (January 2017). Eighty-four patients (15%) had an ED-LOS > 6 hours and a PRISMA-analysis was performed in 74 (88%) of these patients. 269 root causes were identified, 216 (76%) of which were organisational and 53 (22%) patient or disease related. 207 (94%) of the organisational factors were outside the influence of the ED. Descriptive statistics showed a mean number of 2,5 consultations, 59% hospital admissions or transfers and a mean age of 57 years in the ED-LOS > 6 hours group. For the total group, there was a mean number of 1,9 consultations, 29% hospital admissions or transfers and a mean age of 43 years. Conclusions This study showed that the root causes for an increased ED-LOS were mostly organisational and beyond the control of the ED. These results confirm that interventions addressing the complete acute care chain are needed in order to reduce ED-LOS and crowding in ED's.

Original languageEnglish
Article numbere0202751
JournalPLoS ONE
Volume13
Issue number9
DOIs
Publication statusPublished - 1 Sep 2018

Cite this

@article{310443ded69d4183b4867cfa3cfd44c4,
title = "Long length of stay at the emergency department is mostly caused by organisational factors outside the influence of the emergency department: A root cause analysis",
abstract = "Background Emergency department (ED) crowding is common and associated with increased costs and negative patient outcomes. The aim of this study was to conduct an in-depth analysis to identify the root causes of an ED length of stay (ED-LOS) of more than six hours. Methods An observational retrospective record review study was conducted to analyse the causes for ED-LOS of more than six hours during a one-week period in an academic hospital in the Netherlands. Basic administrative data were collected for all visiting patients. A root cause analysis was conducted using the PRISMA-method for patients with an ED-LOS > 6 hours, excluding children and critical care room presentations. Results 568 patients visited the ED during the selected week (January 2017). Eighty-four patients (15{\%}) had an ED-LOS > 6 hours and a PRISMA-analysis was performed in 74 (88{\%}) of these patients. 269 root causes were identified, 216 (76{\%}) of which were organisational and 53 (22{\%}) patient or disease related. 207 (94{\%}) of the organisational factors were outside the influence of the ED. Descriptive statistics showed a mean number of 2,5 consultations, 59{\%} hospital admissions or transfers and a mean age of 57 years in the ED-LOS > 6 hours group. For the total group, there was a mean number of 1,9 consultations, 29{\%} hospital admissions or transfers and a mean age of 43 years. Conclusions This study showed that the root causes for an increased ED-LOS were mostly organisational and beyond the control of the ED. These results confirm that interventions addressing the complete acute care chain are needed in order to reduce ED-LOS and crowding in ED's.",
author = "Driesen, {Babiche E.J.M.} and {Van Riet}, {Bauke H.G.} and Lisa Verkerk and Bonjer, {H. Jaap} and Hanneke Merten and Nanayakkara, {Prabath W.B.}",
year = "2018",
month = "9",
day = "1",
doi = "10.1371/journal.pone.0202751",
language = "English",
volume = "13",
journal = "PLoS ONE",
issn = "1932-6203",
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Long length of stay at the emergency department is mostly caused by organisational factors outside the influence of the emergency department : A root cause analysis. / Driesen, Babiche E.J.M.; Van Riet, Bauke H.G.; Verkerk, Lisa; Bonjer, H. Jaap; Merten, Hanneke; Nanayakkara, Prabath W.B.

In: PLoS ONE, Vol. 13, No. 9, e0202751, 01.09.2018.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Long length of stay at the emergency department is mostly caused by organisational factors outside the influence of the emergency department

T2 - A root cause analysis

AU - Driesen, Babiche E.J.M.

AU - Van Riet, Bauke H.G.

AU - Verkerk, Lisa

AU - Bonjer, H. Jaap

AU - Merten, Hanneke

AU - Nanayakkara, Prabath W.B.

PY - 2018/9/1

Y1 - 2018/9/1

N2 - Background Emergency department (ED) crowding is common and associated with increased costs and negative patient outcomes. The aim of this study was to conduct an in-depth analysis to identify the root causes of an ED length of stay (ED-LOS) of more than six hours. Methods An observational retrospective record review study was conducted to analyse the causes for ED-LOS of more than six hours during a one-week period in an academic hospital in the Netherlands. Basic administrative data were collected for all visiting patients. A root cause analysis was conducted using the PRISMA-method for patients with an ED-LOS > 6 hours, excluding children and critical care room presentations. Results 568 patients visited the ED during the selected week (January 2017). Eighty-four patients (15%) had an ED-LOS > 6 hours and a PRISMA-analysis was performed in 74 (88%) of these patients. 269 root causes were identified, 216 (76%) of which were organisational and 53 (22%) patient or disease related. 207 (94%) of the organisational factors were outside the influence of the ED. Descriptive statistics showed a mean number of 2,5 consultations, 59% hospital admissions or transfers and a mean age of 57 years in the ED-LOS > 6 hours group. For the total group, there was a mean number of 1,9 consultations, 29% hospital admissions or transfers and a mean age of 43 years. Conclusions This study showed that the root causes for an increased ED-LOS were mostly organisational and beyond the control of the ED. These results confirm that interventions addressing the complete acute care chain are needed in order to reduce ED-LOS and crowding in ED's.

AB - Background Emergency department (ED) crowding is common and associated with increased costs and negative patient outcomes. The aim of this study was to conduct an in-depth analysis to identify the root causes of an ED length of stay (ED-LOS) of more than six hours. Methods An observational retrospective record review study was conducted to analyse the causes for ED-LOS of more than six hours during a one-week period in an academic hospital in the Netherlands. Basic administrative data were collected for all visiting patients. A root cause analysis was conducted using the PRISMA-method for patients with an ED-LOS > 6 hours, excluding children and critical care room presentations. Results 568 patients visited the ED during the selected week (January 2017). Eighty-four patients (15%) had an ED-LOS > 6 hours and a PRISMA-analysis was performed in 74 (88%) of these patients. 269 root causes were identified, 216 (76%) of which were organisational and 53 (22%) patient or disease related. 207 (94%) of the organisational factors were outside the influence of the ED. Descriptive statistics showed a mean number of 2,5 consultations, 59% hospital admissions or transfers and a mean age of 57 years in the ED-LOS > 6 hours group. For the total group, there was a mean number of 1,9 consultations, 29% hospital admissions or transfers and a mean age of 43 years. Conclusions This study showed that the root causes for an increased ED-LOS were mostly organisational and beyond the control of the ED. These results confirm that interventions addressing the complete acute care chain are needed in order to reduce ED-LOS and crowding in ED's.

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U2 - 10.1371/journal.pone.0202751

DO - 10.1371/journal.pone.0202751

M3 - Article

VL - 13

JO - PLoS ONE

JF - PLoS ONE

SN - 1932-6203

IS - 9

M1 - e0202751

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