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The association between time to disposition plan in the emergency department and in-hospital mortality of general medical patients.
MedLine Citation:
PMID:  21470357     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Introduction: A perceived risk of time-limited emergency department (ED) assessment of patients is inadequate workup leading to inappropriate disposition. The aim of this study was to examine the association of time to disposition plan (TDP) on Emergency department (ED) length of stay and correlate this to mortality. Methods: A retrospective review of data collected from ED information systems at three hospitals was conducted between June 2008 and October 2009. Included patients were admitted to a general medical unit. Patients were excluded if admitted to intensive care, coronary care, a cardiac monitored bed or required surgery in first 24 hours or had an expected length of stay of <48 hours. Multivariate regression analysis was used to identify independent associations with mortality. Results: A total of 10107 patient episodes were analysed, of which 6768 patients (67.0%) had an ED LOS of ≥8 hours. There was significant effect modification by ED LOS in the association of TDP and mortality. In the setting of longer ED LOS, a TDP of <4 hours was associated with significantly higher mortality (OR 1.57, 95% CI: 1.28-1.92, p < 0.001), corrected for age, gender and triage category. This association was not significant when ED LOS was < 8 hours (OR 0.88. 95% CI: 0.60-1.27; p = 0.49). Conclusions: In the setting of prolonged ED LOS, completing ED assessment and management within 4 hours of presentation was associated with significantly higher mortality. Further prospective studies are required to understand the relationship between rapid decision making in the ED and patient safety.
Authors:
Biswadev Mitra; Peter A Cameron; Peter Archer; Michael Bailey; Paul Pielage; Greg Mele; De Villiers Smit; Harvey Newnham
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-4-6
Journal Detail:
Title:  Internal medicine journal     Volume:  -     ISSN:  1445-5994     ISO Abbreviation:  -     Publication Date:  2011 Apr 
Date Detail:
Created Date:  2011-4-7     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101092952     Medline TA:  Intern Med J     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© 2011 Sydney South West Area Health Service. Journal compilation © 2011 Royal Australasian College of Physicians.
Affiliation:
Emergency & Trauma Centre, The Alfred Hospital Department of Epidemiology & Preventive Medicine, Monash University Emergency Department, Maroondah Hospital Emergency Department, Launceston General Hospital Department of Medicine, The Alfred Hospital.
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