Exploring the factors related to length of stay in emergency departments

Objectives: The National Health Insurance database was used to explore the length of stay (LOS) and related factors in patients utilizing emergency rooms. Methods: In this cross-sectional study, patient use of emergency medical care was analyzed using clinic and hospital claims data from the Bureau of National Health Insurance (BNHI) in 2005. The factors related to emergency department length of stay (EDLOS) were analyzed by logistic regression. Results: There were 6,508,597 persons who had used emergency medical services in 2005, averaging every hundred human of every year 26.43 times. The was 7.7% patients staying at emergency room for observation, 13% and 5.6% of these patients staying at emergency room longer than one and two days for observation, respectively. Patient characteristics associated with EDLOS included old age, male gender, and visiting during a non-holiday. In addition, the presence of urgent medical conditions, comorbidity, or non-serious illness was associated with EDLOS. The regional characteristics associated with EDLOS were as follows: less urbanized area and local visits. Public, medical centers and teaching hospitals with higher occupancy rates and extremely high or low emergency visits were also associated with EDLOS. An observation time of more than one or two days was also influenced by these characteristics including a holiday visit, serious illness, non-urgent illness, visiting at hospital with low emergency department service volume, and cross-boundary visits. Conclusions: The length of stay in emergency rooms still long in Taiwan. Interventions for facilitating emergency medical services are necessary for improving quality.