Emergency departments at "safety-net" hospitals showed timelines similar to those of EDs in other hospitals for admitting, discharging, or transferring patients, according to a national survey published in the Feb. 1 issue of JAMA.
Several measures of ED length of stay have been proposed as indicators of quality of care, including the interval from patient arrival to admission and the interval from admission to discharge or transfer to another facility. Some organizations have suggested that length of stay before discharge should be less than 4 hours and length of stay before admission should be less than 8 hours.
EDs that fail to meet these deadlines would be considered poor performers, and EDs at safety-net hospitals – which provide a disproportionate share of services to poor, uninsured, and Medicaid patients – might be singled out unfairly. "If these measures are tied to pay-for-performance, chronically underfunded safety-net EDs could be at risk of further reductions in funding, which could only exacerbate the lack of resources available in those settings," said Dr. Christopher Fee of the department of emergency medicine, University of California, San Francisco, and his associates.
To examine the issue, the investigators assessed length of stay measures for 24,719 adult ED visits at hospitals across the United States in 2008, the most recent year for which data are available. They used data from the annual National Hospital Ambulatory Medical Care Survey conducted by the Centers for Disease Control and Prevention’s National Center for Health Statistics.
Approximately 42% of these visits were to safety-net EDs and 58% were to non–safety-net EDs.
There were no significant differences between these two types of EDs in any of the median length of stay measures assessed. "Our results show that both safety-net and non–safety-net EDs perform well on the ED length of stay goals that have been proposed, with median ED lengths of stay ... well under 8 hours for admissions and under 4 hours for discharges," Dr. Fee and his colleagues said (JAMA 2012;307:476-82).
The overall length of stay was 269 minutes for safety-net EDs and 281 minutes for non–safety-net EDs. The overall length of stay for critical care admissions was 236 minutes and 248 minutes, respectively.
For discharged patients, the median ED length of stay was 156 minutes in safety-net EDs and 148 minutes in non–safety-net EDs.
It is important to note that although these data are the most current available, they were collected before the economic recession. The recession may well have increased the uninsured and Medicaid populations, which may have affected ED visit volume and length of stay. In addition, the "effects of the sweeping health care reform currently under way remain to be seen," the investigators said.
This study was supported by a grant from the National Institutes of Health/National Center for Research Resources/University of California, San Francisco Clinical and Translational Science Institute and the Robert Wood Johnson Foundation Physician Faculty Scholars Program. Dr. Fee reported ties to Google, and a coauthor is an employee of the National Quality Forum.