Mansbach J M, Clark S, Barcega B R B, Haddad H, & Camargo C A. (2009). Factors Associated With Longer Emergency Department Length of Stay for Children With Bronchiolitis A Prospective Multicenter Study. Pediatric Emergency Care, 25(10), 636-641. ( 10/2009 - Present )
Objectives: Emergency department (ED) length of stay (LOS) is a quality of care measure and, when prolonged, contributes to ED crowding. Bronchiolitis, a common seasonal illness of infants, provides an opportunity to examine factors affecting ED LOS. Methods: We analyzed data from a 30-center prospective cohort study of ED patients younger than 2 years with an attending physician diagnosis of bronchiolitis to determine what factors affect LOS. Researchers conducted a structured interview and chart review. Results: Among 1459 children enrolled, ED LOS was available for 1416 children (97%). The median ED LOS was 3.3 hours (interquartile range, 2.3-4.8 hours). Multivariate analysis demonstrated that factors significantly (P < 0.05) associated with ED LOS were larger annual ED visit volume (reference, lowest tertile [<44,134 visits], 44,134-62,420 [b = 0.74], and >= 62,421 [beta = 0.63]), Hispanic race/ethnicity (reference, white race, beta = 1.43), lack of primary care provider (beta = 1.28), duration of symptoms of 4 to 7 days (reference, <1 day; beta = 0.58), presentation of midnight to 7 AM (reference, 4:00-11:59 PM; beta = 1.07), decreasing lowest oxygen saturation in ED (beta = 0.07), fewer number of beta-agonists during the first hour (beta = 0.74), unknown oral intake (reference, adequate; beta = 0.69), performance of chest x-ray (beta = 0.62), and hospital admission (beta = 1.11). Conclusions: In this prospective multicenter study of children younger than 2 years with bronchiolitis, multiple factors were associated with longer ED LOS. These factors suggest the following steps to help shorten ED LOS: optimizing translation services, improving primary care provider rates, enhancing overnight patient flow, forgoing chest x-rays, and developing evidence-based admission criteria.