Effect of emergency physician-operated emergency short-stay ward on emergency department stay length and clinical outcomes: a case-control study

Abstract

Background We hypothesized that an emergency short-stay ward (ESSW) mainly operated by emergency medicine physicians may reduce the length of patient stay in emergency department without expense of clinical outcomes. Methods We retrospectively analysed adult patients who visited the emergency department of the study hospital and were subsequently admitted to wards from 2017 to 2019. We divided study participants into three groups: patients admitted to ESSW and treated by the department of emergency medicine (ESSW-EM), patients admitted to ESSW and treated by other departments (ESSW-Other) and patients admitted to general wards (GW). The co-primary outcomes were ED length of stay and 28-day hospital mortality. Results In total, 29,596 patients were included in the study, and 8,328 (31.3%), 2,356 (8.9%), and 15,912 (59.8%) of them were classified as ESSW-EM, ESSW-Other and GW groups, respectively. The ED length of stay of the ESSW-EM (7.1h ± 5.4) was shorter than those of the ESSW-Other (8.0 ± 6.2, P < 0.001) and the GW (10.2 ± 9.8, P < 0.001 for both). Hospital mortality of ESSW-EM (1.9%) was lower than that of GW (4.1%, P < 0.001). In the multivariable linear regression analysis, the ESSW-EM was independently associated with shorter ED length of stay compared with the both ESSW-Other (coefficient, 1.08; 95% confidence interval, 0.70–1.46; P < 0.001) and GW (coefficient, 3.35; 95% confidence interval, 3.12–3.57; P < 0.001). In the multivariable logistic regression analyses, the ESSW-EM was independently associated with lower hospital mortality compared with both the ESSW-Other group (adjusted P = 0.030) and the GW group (adjusted P < 0.001). Conclusions In conclusion, the ESSW-EM was independently associated with shorter ED length of stay compared with both the ESSW-Other and the GW in the adult ED patients. Independent association was found between the ESSW-EM and lower hospital mortality compared with the GW.