Emergency Department: Analysis of Patient Flow and Length of Stay Variations

Abstract Background Crowding in Emergency Departments(ED)is a severe public health issue.Length of stay(LOS)is not a direct measure of crowding,but it is an essential indicator for monitoring emergency care quality.LOS in ED can be associated with delays in treatment,decreased patient satisfaction and adverse outcomes.The aim of this study is to analyze ED LOS in the Teaching Hospital of Siena for further strategies. Methods A retrospective observational study was conducted between January 1,2019, and December 31,2021.To manage admissions and discharges, all patients’ data admitted to ED of the University Hospital of Siena were accessed by Aurora,the IT system.In addition,a descriptive analysis was performed, collecting the following variables:sex,age,arrival mode,ED visit reasons,triage code,discharge mode,hospital admission area and LOS(cut-off>8hours).The analysis was carried out using STATA 17:variables were analyzed with ANOVA test. Results Our sample consisted of 152.393 patients (F49.47% M50.53%),and the average age was 50.51(SD ± 26.07).During the years total ED visits decreased:65.426(2019);40.318(2020); 46.649(2021),and there was a significant increase (p < 0.001) of patients with LOS>8 hours:13.96%(2019); 21.51%(2020); 23.10%(2021).In the years 2019,2020 and 2021, admissions of patients with LOS>8 hours were respectively: 25.92%; 43.95% and 37.09%, with the following percentage in medical areas:69.96% in 2019;70.51% in 2020;64.55% in 2021.A progressive increase of admissions in COVID area resulted since 2020(2.23%-2020;6.07%-2021). Conclusions The spread of COVID-19 and the containment measures,such as lockdown,caused a significant decrease in ED access.The increase LOS>8h could be primarily due to the time needed to perform laboratory investigations for the search for SARS-CoV-2 but also to the overflow of SARS-CoV-2-infected patients rapidly saturating the ED boxes and hospital bed capacity,with the need sometimes to dedicate other medical areas to manage COVID patients. Key messages • ED-LOS is a proxy indicator to monitor emergency care quality. • Further investigations should be performed to analyze the leading causes of ED LOS increase during the pandemic period.


Background:
Healthcare-associated infections (HAIs) are the most frequent complications in healthcare settings, with a major impact on adverse outcomes.Here, we aimed to identify the relationships between patients' characteristics admitted to Intensive Care Units (ICUs).

Methods:
We used data of patients included in the ''Italian Nosocomial Infections Surveillance in Intensive Care Units'' (SPIN-UTI) project, who stayed in ICU for more than 2 days.Using Categorical principal component analysis (CATPCA) two components of risk were assessed.Values of variance accounted for (VAF) >0.3 were accepted as the significant effect of a variable on each component.A Chronbach's alpha >0.7 was accepted as a measure of the internal consistency of the model.

Results:
A total of 22402 admissions (62% female) were included.The average age was 65.7 years (SD = 16.6).Our model explains 35.3% of the total variability, with a Cronbach's alpha value of 0.847.The visual examination of component loading plot allows to evaluate the correlation between the quantified variables and each of the two components.In particular, the first component is explained by the presence of intubation (VAF = 0.826), central venous catheter (VAF = 0.749), and urinary catheter (VAF = 0.727), patient's origin (VAF = 0.584), antibiotic treatment (VAF = 0.479), non-surgical treatment for acute coronary disease (VAF = 0.375), type of admission (VAF = 0.509), surgical intervention (VAF = 0.419).In the second component, the variables with the greatest contribution were the SAPS II (VAF = 0.660), age (VAF = 0.583), type of admission (VAF = 0.531), surgical intervention (VAF = 0.522).Thus, the first component would represent the exposure to invasive devices and medical procedures, and the second component the severity of patients.

Conclusions:
Our results proposed the usefulness of CATPCA to identify factors involved in the development of adverse outcomes, highlighting the role of exposure to invasive devices and severity of patients.

Background:
Crowding in Emergency Departments(ED)is a severe public health issue.Length of stay(LOS)is not a direct measure of crowding,but it is an essential indicator for monitoring emergency care quality.LOS in ED can be associated with delays in treatment,decreased patient satisfaction and adverse outcomes.The aim of this study is to analyze ED LOS in the Teaching Hospital of Siena for further strategies.

Methods:
A retrospective observational study was conducted between January 1,2019, and December 31,2021.To manage admissions and discharges, all patients' data admitted to ED of the University Hospital of Siena were accessed by Aurora,the IT system.In addition,a descriptive analysis was performed, collecting the following variables:sex,age,arrival mode,ED visit reasons,triage code,discharge mode,hospital admission area and LOS(cut-off>8hours).The analysis was carried out using STATA 17:variables were analyzed with ANOVA test.

Conclusions:
The spread of COVID-19 and the containment measures,such as lockdown,caused a significant decrease in ED access.The increase LOS>8h could be primarily due to the time needed to perform laboratory investigations for the search for SARS-CoV-2 but also to the overflow of SARS-CoV-2-infected patients rapidly saturating the ED boxes and hospital bed capacity,with the need sometimes to dedicate other medical

Background:
Tertiary metabolic health services are in high demand as people with severe obesity increase.Once predetermined health goals have been achieved patients must transition to community-based care to urgently free up capacity in tertiary services.Maintenance of successful outcomes achieved via tertiary services is therefore important to limit rates of relapse back to these services.

Methods:
This qualitative project explored community-based care needs to help individuals living with obesity maintain health gains.An interview schedule guided one-on-one interviews with patients and staff from metabolic clinics in Sydney, Australia.

Results:
We interviewed 22 patients and 13 clinicians.A lack of appropriate and consistent clinical support in the community was identified by patients and clinicians.Most clinicians agreed primary care was key to successful maintenance care.Lack of primary care understanding of appropriate management and support for patients with obesity, lack of bariatric equipment and limited funding for allied health were all seen barriers to appropriate support beyond their clinics.Patients were highly reluctant to transition from tertiary clinics and reluctant to engage with community-based care due to experience of limited clinical/social support and bariatric equipment, demeaning clinical interactions, lack of care coordination and being stigmatised.Support groups outside of the clinic were also identified important in mitigating social isolation and stigma.Both patients and clinicians felt support groups have potential to provide important supplementary help to individuals with obesity outside tertiary settings.Conclusions: Currently, individuals aiming to maintain their weight are likely to struggle in the context of existing community care