Investigating the areas of delay associated with prolonged length of stay in an emergency department in a tertiary hospital in Gauteng

Abstract

Background: Prolonged length of stay in an emergency department, which affects quality patient care and patient outcomes negatively, is a worldwide problem. Aim: The aim of this study was to describe associated areas of delay in the emergency department and also to investigate factors influencing prolonged length of stay in this department. The study also would suggests recommendations to address delay in the emergency department. Research design and methods: A quantitative, non-experimental, descriptive, retrospective study of the files of 100 patients who were managed in the emergency department of a tertiary hospital in Gauteng, South Africa from June to August 2015 was conducted. An audit tool was developed, guided by the input-throughput-output model. Patient files were sampled systematically to be audited and to collect data. During the data analysis, descriptive statistics, regression analysis, regression diagnostics, stepwise regression and Durbin-Watson statistics were used. Results: Due to lack of capacity the relevant emergency department experienced difficulties in dealing effectively with the numbers of patients arriving at the department. This was one of the factors that led to an increase in the length of stay (the average of which was 3.04 days). The following areas of delay possibly causing an increase in length of stay were reception and triage, triage doctor, speciality referral and specialist consultation, trauma lying area, female medical area, internal medicine department, pathology department and inpatient beds. Conclusion: Prolonged length of stay was experienced in the emergency department of the study hospital. Revising the referral system of patients to the hospital and doctors' system of referring patients to specialists, monitoring the time specialists take to consult with patients and the disposition of patients, and evaluating the availability of inpatient beds might improve the situation.