"Does emergency medicine length of stay predict trauma outcomes at a Level I Trauma Center?" was published online in the Journal of Hospital Administration on May 28.
The retrospective database review looked at Level I and Level II activated adult trauma patients at Saint Louis University Hospital admitted from July 1, 2010 to June 30, 2011.
The study's authors looked to assess the relationship between a trauma patient's emergency department length of stay (EDLOS) on hospital length of stay and mortality.
The American Trauma Society defines a Level I Trauma Center as a comprehensive regional resource that is capable of providing total care for every aspect of injury -- from prevention through rehabilitation.
The data analysis showed while high volume did increase a trauma patient's length of stay in the emergency department there was no association between staying in the ED more than four hours and mortality in trauma patients.
Author Preeti Dalawari, M.D., M.S.P.H., associate professor at Saint Louis University and a SLUCare Physician Group emergency department doctor at Saint Louis University Hospital, said the study showed that the ED's systems were able to accommodate a fluctuating volume of patients without posing a significant risk to trauma patients.
"I suspect this is due to the coordinated care between the ED and Trauma teams; however the demands on resources and manpower may add to the length of stay or morbidity of other patients.
"We are at an all time high for patients in the ER," Dalawari said. "We are extremely busy and with the Affordable Care Act, we've only gotten busier."
She noted that ED overcrowding is a pressing issue, and critically ill patients boarding in the emergency department use substantial resources, especially the time of emergency physicians and nurses.
"Overcrowding may impact overall patient satisfaction and hospital staff stress, but the primary outcome for trauma care - survival - remained favorable at about 4.5 percent," said co-author Eric Armbrecht of the Center for Outcomes Research at Saint Louis University.
Hospital capacity data at the time of trauma activation was collected from the hospital bed board. This capacity data included absolute numbers of available physical beds, staffed beds, floor beds and ICU beds at the time of the leveled trauma patients' arrivals.
The emergency department length of stay was categorized as short if the duration was less than four hours. The study found approximately two-thirds of patients stayed in the emergency department for four hours or less.
The review found severely injured patients have a longer hospital length of stay regardless of how long they are in the emergency room. The Level I and II patients were evaluated as they came into the hospital.
Dalawari said that trauma events in St. Louis tend to be very seasonal - blunt force traumas from car accidents and falls in the winter and gunshot wounds and motorcycle accidents in warm weather months.
"As a trauma center based in the city of St. Louis, we see a real mix of cases," Dalawari said.
Level I trauma centers for adults in the St. Louis area include Saint Louis University Hospital, Barnes-Jewish Hospital and Mercy Hospital.
Other authors included Erin Powers Kinney and Kamal Gursahani of Saint Louis University's School of Medicine, Division of Emergency Medicine.
Established in 1836, Saint Louis University School of Medicine has the distinction of awarding the first medical degree west of the Mississippi River. The school educates physicians and biomedical scientists, conducts medical research, and provides health care on a local, national and international level. Research at the school seeks new cures and treatments in five key areas: infectious disease, liver disease, cancer, heart/lung disease, and aging and brain disorders.
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