Publication: A study on factors influencing waiting time for admission at observation ward, emergency department Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan
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Date
2014
Authors
Razally, Illiana Syahmun Mohd
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Abstract
A study on factors influencing waiting time for admission at Observation Ward, Emergency Department HUSM, Kubang Kerian, Kelantan. Introduction: Overcrowding is one of the major problems in Emergency Department. In USA it was reported that there was an increase by 1% of emergency patients yearly. Observation ward is one of the buffer systems in reducing overcrowding in Emergency Department. Patients kept in observation ward for assessment and progression of treatment and later were categorized into those who could be discharged or those for admission. 30% of our patients from observation ward were due for admission and this study focused on this group of patients. Objectives: The length of stay from the decision for admission until patient admitted to respective ward and factors influencing length of stay and delay before admission among those patients were identified. Outcome of the patients in term of morbidity and mortality while waiting for admission were studied. Methods: This prospective study was conducted in EDOW HUSM by collecting continuous data over 6 months from May 2012 to October 2012. All patients who were treated in observation ward Emergency Department and decided for admission to the respective ward during the study period were included. Decision for admission was considered the moment the respective doctor ordered for patient admission. Reasons for delay in admitting patient once ordered were documented. Prolonged length of stay in this study means the patients stayed more than 3 hours at EDOW after being ordered for admission. A cross sectional study was conducted through review of data collected. Data analysis was done using SPSS version 20.0. Result: 764 patients were due for admission to the respective wards. The mean age was 37 year old, with predominantly Malay and male gender. Majority of the admissions occurred on weekdays and highest on Tuesday. This might be influenced by teaching day on Tuesday leading to an increase in the number of patients waiting for laboratory results in EDOW. Numbers of admission were highest during night shift. Majority of the patients admitted within less than 3 hours with mean of stay 56.61 (77) minutes. Reasons for late admission were identified as bed problem, staff problem, working shift transition time, ward busy or waiting for patients’ old files. Out of 764 patients, 3 patients were transfer out back to treatment area, one to red zone and another two cases to yellow zone. Through multiple logistic regression analysis, significant associated factors identified for waiting time more than 3 hours were non-holiday or weekdays (OR: 3.08; 95% CI: 1.27, 7.47; p = 0.013) and morning shift (OR:5.865 %CI: 2.637, 13.047; p = 0.000). Conclusion: The main factors associated with prolonged EDOW stay were weekdays and morning shift.
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Keywords
length of stay , factors delay