Longer time to transfer from the emergency department after bed request is associated with worse outcomes

OBJECTIVE: To determine the relationships between: (i) total ED length of stay (EDLOS) and in-hospital mortality, ward clinical deterioration; and (ii) between time of bed request, ward transfer and in-hospital mortality, with a particular focus on patients transferred just prior to a 4 h EDLOS. METHODS: Retrospective cohort study using data from three acute care hospitals in Melbourne, Australia. Adult patients admitted from the ED to a non-monitored ward within 8 h. Patients were sub-grouped by EDLOS; EDLOS 3.5-4 h compared to 0-3.5 h and 4-8 h. In-hospital mortality, number of medical emergency team (MET)/cardiac arrest team (CAT) events. RESULTS: A total of 24 746 patients were included: 4396 patients with EDLOS <210 min; 4090 patients with EDLOS of 210-240 min; and 16 260 patients with EDLOS >240 min. Mortality overall was 2.2% (n = 545), highest mortality was seen with EDLOS >4 h (2.4%, n = 399) and lowest in patients with EDLOS 3.5-4 h (1.5%, n = 63, OR 0.67 [95% CI: 0.47-0.93, P = 0.02]). Time from bed request to transfer of >240 min was associated with increased odds of death at hospital discharge (adjusted OR 1.39 [95% CI: 1.08-1.78]). There was no difference in rate of MET calls within 24 h between groups (3.5-4 h = 64 [1.5%], <3.5 h = 60 [1.5%], 4-8 h = 235 [1.4%]). CONCLUSIONS: Both shorter time in ED and shorter time between bed request and ward transfer were independently associated with improved outcomes. Whole of hospital measures to reduce length of stay in the ED should focus on shorter ward transfer times after bed request.