Investigating the areas of delay associated with prolonged length of stay in an emergency department in a tertiary hospital in Gauteng

Background: Prolonged length of stay in an emergency department, which affects quality patient care and patient outcomes negatively, is a worldwide problem. Aim: The aim of this study was to describe associated areas of delay in the emergency department and also to investigate factors influencing prolonged length of stay in this department. The study also would suggests recommendations to address delay in the emergency department. Research design and methods: A quantitative, non-experimental, descriptive, retrospective study of the files of 100 patients who were managed in the emergency department of a tertiary hospital in Gauteng, South Africa from June to August 2015 was conducted. An audit tool was developed, guided by the input-throughput-output model. Patient files were sampled systematically to be audited and to collect data. During the data analysis, descriptive statistics, regression analysis, regression diagnostics, stepwise regression and Durbin-Watson statistics were used. Results: Due to lack of capacity the relevant emergency department experienced difficulties in dealing effectively with the numbers of patients arriving at the department. This was one of the factors that led to an increase in the length of stay (the average of which was 3.04 days). The following areas of delay possibly causing an increase in length of stay were reception and triage, triage doctor, speciality referral and specialist consultation, trauma lying area, female medical area, internal medicine department, pathology department and inpatient beds. Conclusion: Prolonged length of stay was experienced in the emergency department of the study hospital. Revising the referral system of patients to the hospital and doctors' system of referring patients to specialists, monitoring the time specialists take to consult with patients and the disposition of patients, and evaluating the availability of inpatient beds might improve the situation.Dissertation (MCur)--University of Pretoria, 2016.Nursing ScienceMCurUnrestricte

Areas of delay related to prolonged length of stay in an emergency department of an academic hospital in South Africa

INTRODUCTION: Globally, length of stay of patients in emergency departments remains a challenge. Remaining in the emergency department for >12 h increases health care costs, morbidity and mortality rates and leads to crowding and lower patient satisfaction. The aim of this research was to describe the areas of delay related to prolonged length of stay in the emergency department of an academic hospital. METHODS: A quantitative retrospective study was done. The Input-Throughput-Output model was used to identify the areas of patients’ journey through the emergency department. The possible areas of delay where then described. Using systematic sampling, a total of 100 patient files managed in an emergency department of an academic hospital in South Africa were audited over a period of 3 months. Descriptive statistics and regression analysis was used to analyse data. RESULTS: The mean length of stay of patients in the emergency department was 73 h 49 min. The length of stay per phase was: input (3 h 17 min), throughput (16 h 25 min) and output (54 h 7 min). A strong significant relationship found between the length of stay and the time taken between disposition decision (throughput phase) disposition decision to admission or discharge of patients from the ED (output phase) (p < 0.05). CONCLUSION: The output phase was identified as the longest area of delay in this study, with the time taken between disposition decision to admission or discharge of patients from the ED (patients waiting for inpatient beds) as the main significant area of delay.https://www.elsevier.com/locate/afjempm2021Human NutritionNursing Scienc