Emergency department length of stay independently predicts excess inpatient length of stay

Objective: To examine the association between emergency department length of stay (EDLOS) and inpatient length of stay (IPLOS). Design: Retrospective review of presentations and admissions data. Setting: Three metropolitan hospitals in Melbourne, 1 July 2000 to 30 June 2001. Main outcome measures: Mean I PLOS for four categories of EDLOS (less than or equal to 4 hours, 4-8 hours, 8-12 hours, >12 hours); excess IPLOS, defined as IPLOS exceeding state average length of stay; odds ratios for excess IPLOS adjusted for age, sex and time of presentation. Results: 17 954 admissions were included. Mean IPLOS for the four categories of EDLOS were less than or equal to 4 hours, 3.73 days; 4-8 hours, 5.65 days; 8-12 hours, 6.60 days; > 12 hours, 7.20 days (P<0.001). The corresponding excess IPLOS were 0.39, 1.30, 1.96 and 2.35 days (P<0.001). Compared with EDLOS 4-8 hours, odds ratios (95% Cls) for excess IPLOS associated with the other three categories of EDLOS were less than or equal to 4 hour, 0.68 (0.63-0.74); 8-12 hours, 1.20 (1.10-1.30); and > 12 hours, 1.49 (1.36-1.63), after adjusting for elderly status, sex and time of ED presentation. Conclusion: EDLOS correlates strongly with IPLOS, and predicts whether IPLOS exceeds the state benchmark for the relevant diagnosis-related group, independently of elderly status, sex and time of presentation to ED. Strategies to reduce EDLOS (including countering access block) may significantly reduce healthcare expenditure and patient morbidity.