Influence of length of ED stay on in-hospital mortality in a Spanish tertiary referral center

Objectives.

To analyze the length of emergency department (ED) stay prior to hospital admission, its causes, and repercussions on patient health.

Methods.

We conducted a retrospective observational study of length of ED stay for patients requiring hospitalization in adult medical specialties at a tertiary referral center in Spain from 2022 through 2023. We analyzed the different time intervals between triage and
arrival at the hospital ward.

Results.

A total of 257,814 adult patients were seen in the ED during this period. Of these, 21,984 (8.5%) were admitted to various
medical services. Men accounted for 55.1%, and women were older [75 (SD, 20) vs 72 (SD, 15) years; P < .001]. The mean ED stay was 22.8 hours (SD, 14.3), with 61.4% of this time dedicated to administrative processes and ward placement. Notably, 48% of patients stayed more than 12 hours, while 6% stayed less than 4 hours. Log-rank analysis showed higher in-hospital mortality among patients who stayed longer in the ED (P = .002). However, this association was not confirmed in multivariate analysis, which did reveal a significant relationship between hospital mortality, age, and admission to an “ectopic” bed (eg, outside the specific unit of the destination service) (P < .001).

Conclusions.

There is a need to optimize administrative and logistical processes in the ED to reduce waiting times and enhance patient safety.