J Korean Soc Emerg Med.  2020 Oct;31(5):518-525.

Analysis of emergency department length of stay in patient with severe illness code

• Baek SM
• Seo DW
• Kim YJ
• Jeong J
• Kang H
• Han KS
• Kim SJ
• Lee SW
• Kim WY

Abstract

Objective
Emergency department (ED) overcrowding is a global trend that has negative impacts on the clinical outcomes, especially on critically ill patients. Reducing the portion of these critical patients by limiting the ED length of stay (LOS) to less than 6 hours has become one of the most crucial targets of government policy. This could be valuable for resolving overcrowding, but the clinical impacts and applicability had not been evaluated.
Methods
Consecutive emergency patients registered on the National Emergency Department Information System from January 2016 to December 2017 were analyzed. This study included critically ill patients who had a severe illness code, as defined by the government. The in-hospital mortality rate was compared by under or over six hours of ED LOS, in patients with a severe illness code, and intensive care unit (ICU) patients.
Results
Among 18,217,034 patients, 436,219 patients had a severe illness code. The ED LOS in the less than six hours group showed a higher in-hospital mortality rate than that of more than six-hours group (7.1% vs. 6.5%, respectively). When the rule for the severe illness code to ICU admission was changed, the in-hospital mortality rate showed a remarkable difference between the under and over six-hour group (12.8% vs. 15.0%, respectively). The proportion of critically ill patients admitted within six hours increased when the standard for outlier removal was set higher than the current.
Conclusion
A more suitable quality indicator or criterion for severe illness code is required for improving the clinical outcomes.

Keyword

Length of stay; Administration; Healthcare quality indicator