Factors Relating to Decision Delay in the Emergency Department: Effects of Diagnostic Tests and Consultations

Abstract

Purpose

The purpose of this study is to investigate the factors increasing waiting time (WT) and length of stay (LOS) in patients, which may cause delays in decision-making in the emergency departments (ED).

Patients and Methods

Patients who arrived at a training hospital in the central region of Izmir City, Turkey, during the first quarter of 2020 were retrospectively analyzed. WT and LOS were the outcome variables of the study, and gender, age, arrival type, triage level determined based on the clinical acuity, diagnosis encoded based on International Classification of Diseases-10 (ICD-10), the existence of diagnostic tests or consultation status were the identified factors. The significance of the differences in WT and LOS values based on each level of these factors was analyzed using independent sample t-tests and ANOVA.

Results

While patients for which no diagnostic testing or consultation was requested had a significantly higher WT in EDs, their LOS values were substantially lower than those for which at least one diagnostic test or consultation was ordered (p≤0.001). Besides, elderly and red zone patients and those who arrived by ambulance had significantly lower WT and higher LOS values than other levels for all groups of patients for which laboratory-type or imaging-type diagnostic test or consultation was requested (p≤0.001 for each comparison).

Conclusion

Besides ordering diagnostic tests or consultation in EDs, different factors may extend patients’ WT and LOS values and cause significant decision-making delays. Understanding the patient characteristics associated with longer waiting times and LOS values and, thus, delayed decisions will enable practitioners to improve operations management in EDs.

Keywords:

• emergency department
• waiting time
• length of stay
• delay

Abbreviations

ED, emergency department; WT, waiting time (time between admission and arrival); LOS, length of stay (time between departure and arrival); ICD-10, International Classification of Diseases-10; A00-B99, Certain infectious and parasitic diseases; C00-D49, Neoplasms; D50-D89, Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism; E00-E89, Endocrine, nutritional and metabolic diseases; F01-F99, Mental, Behavioral and Neurodevelopmental disorders; G00-G99, Diseases of the nervous system; H00-H59, Diseases of the eye and adnexa; H60-H95, Diseases of the ear and mastoid process; I00-I99, Diseases of the circulatory system; J00-J99, Diseases of the respiratory system; K00-K95, Diseases of the digestive system; L00-L99, Diseases of the skin and subcutaneous tissue; M00-M99, Diseases of the musculoskeletal system and connective tissue; N00-N99, Diseases of the genitourinary system; O00-O9A, Pregnancy, childbirth and the puerperium; P00-P96, Certain conditions originating in the perinatal period; Q00-Q99, Congenital malformations, deformations and chromosomal abnormalities; R00-R99, Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified; S00-T88, Injury, poisoning and certain other consequences of external causes; U00-U85, Codes for special purposes; V00-Y99, External causes of morbidity; Z00-Z99, Factors influencing health status and contact with health services.

Declaration of Helsinki

Guidelines outlined in the Declaration of Helsinki were followed.

Ethics Committee Approval

İzmir Bakırçay University, Non-interventional Clinical Studies, Institutional Review Board, approved in 30.11.2022 meeting, Approval ID:790, Research ID:770.

Informed Consent

Not required. This study is a retrospective and database study. Data acquired is kept anonymized.

Disclosure

The authors report no conflicts of interest in this work.