The Effect of Number of Visits, Length of Stay (LOS), and Emergency Room Density on Mortality in the Emergency Room of Malang City Tertiary Hospital
Research
DOI:
https://doi.org/10.55175/cdk.v51i11.1378Keywords:
ED crowding, ED visits, LOS, mortalityAbstract
Introduction: Emergency department (ED) mortality is a critical issue that has a major impact on individuals, society, and the entire health system and is one of the indicators of emergency department service performance. This research aims to provide input to hospital management regarding the impact of non-medical factors (number of visits, length of stay/LOS, and ED crowding) on patient mortality, related to improvement policy-making in ED patient services. Method: A retrospective study on 130 ED shifts from medical record data during 2022-2023. The independent variables were the number of visits, LOS, ED crowding measured by CEDOCS, and ED mortality as the dependent variable. Results: There were deaths in 38 out of 130 shifts in the ED, with a total mortality of 1.6%. Statistical tests showed a significant effect between crowding and ED mortality (p = 0.01), a non-significant effect between visits and ED mortality (p = 0.76), and a non-significant effect between LOS and ED mortality (p = 0.62). The results of the regression analysis were able to explain the data (p = 0.91; Hosmer-Lameshow test). The area under the curve (AUC) for prognosis in hospital treatment is 0.641 with a 95% confidence interval of 0.539-0.744 (medium category). Conclusion: The significant effect between crowding and patient mortality in the ED indicates that strategic management must be carried out to reduce ED crowding.
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References
Yunus. Efektivitas pelayanan gawat darurat berdasarkan emergency response time. Direktorat Jenderal Pelayanan Kesehatan; 2022 .p. 1–2.
Almass A, Aldawood MM, Aldawd HM, AlGhuraybi SI, Al Madhi AA, Alassaf M, et al. A systematic review of the causes, consequences, and solutions of emergency department overcrowding in Saudi Arabia. Cureus 2023;15(12):1–11. DOI: 10.7759/cureus.50669.
Alnasser S, Alharbi M, Aalibrahim A, Ibrahim AA, Kentab O, Alassaf W, et al. Analysis of emergency department use by non-urgent patients and their visit characteristics at an academic center. Int J Gen Med. 2023;16:221–32. DOI: 10.2147/IJGM.S391126.
Abebe F, Habtamu A, Workina A. Risks of early mortality and associated factors at adult emergency department of Jimma university medical center. Open Access Emerg Med. 2023;15:293–302. DOI: 10.2147/OAEM.S420660.
Tarkie K, Altaye KD, Berhe YW. Current patterns of care at adult emergency department in Ethiopian tertiary university hospital. Int J Emerg Med. 2023;16(1):1–7. DOI: 10.1186/s12245-023-00502-3.
Belayneh AG, Temachu YZ, Messelu MA, Gebrie MH. Prolonged length of stay and its associated factors at adult emergency department in Amhara region comprehensive specialized hospitals, northwest Ethiopia. BMC Emerg Med. 2023;23(1):1–11. DOI: 10.1186/s12873-023-00804-y.
Limantara R, Herjunianto H, Roosalina A. Faktor-faktor yang mempengaruhi tingginya angka kematian di IGD rumah sakit. J Kedokt Brawijaya. 2015;28(2):200–5. DOI:10.21776/ub.jkb.2015.028.02.15.
Savioli G, Ceresa IF, Gri N, Piccini GB, Longhitano Y, Zanza C, et al. Emergency department overcrowding: Understanding the factors to find corresponding solutions. J Pers Med. 2022;12(2):1-14. DOI: 10.3390/jpm12020279.
Otto R, Blaschke S, Schirrmeister W, Drynda S, Walcher F, Greiner F, et al. Length of stay as quality indicator in emergency departments: Analysis of determinants in the German emergency department data registry (AKTIN registry). Intern Emerg Med. 2022;17(4):1199–209. DOI: 10.1007/s11739-021-02919-1.
van der Veen D, Remeijer C, Fogteloo AJ, Heringhaus C, de Groot B. Independent determinants of prolonged emergency department length of stay in a tertiary care centre: A prospective cohort study. Scand J Trauma Resusc Emerg Med. 2018;26(1):1–14. DOI: 10.1186/s13049-018-0547-5.
Sartini M, Carbone A, Demartini A, Giribone L, Oliva M, Spagnolo AM, et al. Overcrowding in emergency department: Causes, consequences, and solutions-A narrative review. Healthc. 2022;10(9):1–13. DOI: 10.3390/healthcare10091625.
Kementerian Kesehatan Republik Indonesia. Peraturan Menteri Kesehatan Republik Indonesia nomor 30 tahun 2022 tentang indikator nasional mutu pelayanan kesehatan tempat praktik mandiri dokter dan dokter gigi, klinik, pusat kesehatan masyarakat, rumah sakit, laboratorium kesehatan. Kementerian Kesehatan 2022;(30):1–94.
Phillips JL, Jackson BE, Fagan EL, Arze SE, Major B, Zenarosa NR, et al. Overcrowding and its association with patient outcomes in a median-low volume emergency department. J Clin Med Res. 2017;9(11):911–6. DOI: 10.14740/jocmr3165w.
Mahmoodi S, Faraji M, Shahjooie F, Azadpour A, Ghane MR, Javadzadeh HR, et al. Effect of emergency department crowding on patient mortality: A systematic review. Trauma Mon. 2023;28(3):831–40. DOI: 10.30491/tm.2023.398856.1600.
Parvaresh-Masoud M, Cheraghi MA, Imanipour M. Nurses’ perception of emergency department overcrowding: A qualitative study. J Educ Health Promot. 2023;12:1–8. DOI: 10.4103/jehp.jehp_1789_22.
Service Design and Configuration Committee RCEM. The management of emergency department crowding. R Coll Emerg Med. 2024;1:1–28.
ACEP. Emergency department crowding: High impact solutions. Emerg Med Pract Comm. 2016;1:1–20.
Al-Qahtani MF, Khubrani FY. Exploring potential association between emergency department crowding status and patients’ length of stay at a university hospital in Saudi Arabia. Open Access Emerg Med. 2021;13:257–63. DOI: 10.2147/OAEM.S305885.
Wretborn J, Wilhelms DB, Ekelund U. Emergency department crowding and mortality: An observational multicenter study in Sweden. Front Public Heal. 2023;11:1–7. DOI: 10.3389/fpubh.2023.1198188.
Khubrani FY, Al-Qahtani MF. Association between emergency department overcrowding and mortality at a teaching hospital in Saudi Arabia. Open Public Health J. 2021;13(1):756–62. DOI: 10.2174/1874944502013010756.
Chang AM, Cohen DJ, Lin A, Augustine J, Handel DA, Howell E, et al. Hospital strategies for reducing emergency department crowding: A mixed-methods study. Ann Emerg Med. 2018;71(4):497-505.e4. DOI: 10.1016/j.annemergmed.2017.07.022.
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