Timeliness: Emergency Department Length of Stay
Why is this measure important?
When children need emergency care, it is important that they be treated quickly and either be admitted to the hospital or sent home. Emergency rooms can be busy and chaotic places. In general, they are not good places for children unless the situation is a real emergency or the child’s regular doctor is not available and the problem requires immediate medical attention. In either case, children should only remain in the emergency room as long as is necessary to stabilize or treat their condition.
How do we track this measure?
We track the number of minutes children spend in the emergency room before either being stabilized and admitted to the hospital or being treated and sent home. Since children who are admitted to the hospital are much sicker than those who are sent home, we track the time they spend in the emergency room separately.
Each year, we look at the median length of stay for both children who are admitted to the hospital and those who are sent home. A median length of stay means that half of the patients stayed in the emergency room for a shorter period of time and half stayed in the emergency room for a longer period of time.
How do we compare to other hospitals?
Because there is no agreement on how long a child should stay in an emergency room, this measure cannot be used to compare us with other hospitals. Instead, we have developed our own targets based on our own experience with emergency room care.
For children who are stabilized and admitted to the hospital, our target is a median length of stay of less than 4.5 hours. For children are treated and sent home, our target is a median length of stay is less than 3 hours.
As of the second quarter of 2010, our emergency department length of stay for discharged patients was just above our target of 3 hours. For admitted patients, it was one hour longer than our target of 4.5 hours. Our length of stay for discharged patients was 3.1 hours, and our length of stay for admitted patients was 5.5 hours.
What are we doing to improve?
Children’s Hospital Boston saw a record 63,000 patients in its emergency room in calendar year 2009, up from 50,000 just a few years ago. Emergency department crowding continues to be a tremendous challenge across the U.S., in part because of the shortage of primary care physicians to take care of routine health problems.
To care for these additional patients, we have added physicians and nurses and maximized the use of our “fast track” treatment area for patients with less serious problems. We are also expanding our emergency department, with additional space and resources to be available for patients by the fall of 2011.
Finally, our nurses and doctors are working to shorten the time it takes for patients who need hospital care to be moved out of the emergency room to an available bed in the hospital.