Understanding the significant factors affecting prolonged length of stay for adult trauma patients in the Emergency Department: an extended narrative review.

Abstract

Background Time is a very important variable for measuring trauma care as it plays a crucial role in morbidity and mortality rates. Therefore, measuring Emergency Department Length of Stay (ED LOS) has become a good quality indicator in trauma care to ensure patient satisfaction and to avoid any negative consequences for both patients and the health care system. As a result, significant factors leading to prolonged ED LOS should be investigated to develop new protocols, guidelines or standards which will help mitigate these. Objectives 1- Criticallyexplorepatient-,ED-andhealthsystem-relatedfactors associated with prolonged length of stay for adult trauma patients in the Emergency Department. 2- Identifygapsinthecurrentresearchinordertoaddresstheseinfuture studies. 3- Presentbriefrecommendationsonwhatcouldbeimprovedtoreduce length of stay and how. Search strategy A scoping search, conduct search, bibliography search, verification and documentation were the five search strategies used in this review. The PICO framework was used to guide the search and to identify relevant search terms. 8

Six electronic databases, including PubMed, Scopus, Medline ALL, CINHAL, Cochrane, and Web of Science, were searched to identify relevant studies. Results A total of eight studies were included in this review. The methodological design adopted for this paper was cohort. Based on evidence hierarchy, this is of low methodological quality. The significant factors leading to prolonged ED LOS were classified into three groups which included patient-, ED- and system- related issues. Conclusion The ED LOS measurement is a key parameter for evaluating the quality of trauma care delivered to critically ill patients post-traumatic injury. However, there are significant factors impacting on ED LOS, leading to a long wait time in the ED. Patient’s characteristics can determine ED LOS; however, ED- and system-related factors should also be considered to measure overall time spent in the ED.