Data Analysis of Emergency Department Length of Stay for Patients Presenting with Headaches

Eitan Giat, Michael Dreyfuss, Yahel Giat
InSITE 2023  •  2023  •  pp. 019
Patients’ length of stay in emergency departments (ED) is a widespread problem that poses great hardship on patients and health providers alike. This paper’s purpose is to reduce length of stay (LOS) for patients presenting to the ED with headaches.

The increasing number of patients admitted to emergency departments challenges administrators to find ways to reduce the length of stay in the ED. The purpose of this paper is to quantify the potential reduction in LOS by modifying patient flow in the ED, for patients presenting with non-traumatic headache who require a non-contrast head computerized tomography (CT).

A 41-month retrospective review was performed for all patients presenting to the Sheba ED with non-traumatic headache as the chief complaint and that were referred to CT during their visit. We distinguished between patients that had undergone the standard patient flow of first seeing a physician and only then referred to CT and patients that were sent to CT directly from the triage station, which is run by a triage nurse. For the former group, we identified their main patient flow epochs: arrival, triage nurse, physician referral to CT, performing CT, discharge.

The contribution is two-fold. First, a practical recommendation for changes in patient workflow to reduce LOS. Second, it demonstrates how medical records can be used to analyze “what-if” scenarios on patient flow.
Findings During the period under review, there were 5501 headache patients out of a total of 196681 walk-in ED visits, a ratio of 2.79% (95% confidence interval [95% CI]: 2.72%-2.86%). Of the headache patients, 2961 patients were referred to CT and their LOS was 394 minutes (95% CI: 387-401). Modifying the standard patient flow so that patients are sent from triage immediately to CT will potentially reduce 121 minutes (95% CI: 118-124) from their LOS. These potential savings are concentrated mainly in the p.m. hours.

Recommendations for Practitioners.
The potential LOS reduction can be achieved by modifying current patient flow for patients presenting to the ED with non-traumatic headache. Modifications should focus on late afternoon and evening hours. Accordingly, different proposals addressing the nature of these proposals are discussed.

Recommendations for Researchers.
There is a plethora of information available in electronic medical records, which is yet to be harnessed to improve the management of health systems. Researchers could apply techniques used in this paper to benefit the health systems.

Impact on Society.
Reducing LOS will positively affect not only patients who will receive faster service, but also health provider that are currently are operating in a crowded and stressful environment.

Future Research.
The research can be expanded to other common patient main complaints such as abdominal pain or orthopedic injuries.
electronic medical records, emergency department, length of stay, patient flow
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