Annals of Emergency Medicine
Volume 49, Issue 3 , Pages 265-271 , March 2007

Time Series Analysis of Variables Associated With Daily Mean Emergency Department Length of Stay

Presented at the American College of Emergency Physicians Research Forum, October 2004, San Francisco, CA.

  • Niels K. Rathlev, MD

      Affiliations

    • Departments of Emergency Medicine (Rathlev, Olshaker, Obendorfer, Mehta, Rothenhaus, Crespo, Magauran, Fisher)
    • Corresponding Author InformationAddress for correspondence: Niels K. Rathlev, MD, Department of Emergency Medicine, Boston Medical Center, One Boston Medical Center Place, Boston, MA 02118; 617-414-5963, fax 617-414-7759
    • ,
  • John Chessare, MD, MPH

      Affiliations

    • Departments of Emergency Medicine (Rathlev, Olshaker, Obendorfer, Mehta, Rothenhaus, Crespo, Magauran, Fisher)
    • ,
  • Jonathan Olshaker, MD

      Affiliations

    • Departments of Emergency Medicine (Rathlev, Olshaker, Obendorfer, Mehta, Rothenhaus, Crespo, Magauran, Fisher)
    • ,
  • Dan Obendorfer, MBA, MIS

      Affiliations

    • Departments of Emergency Medicine (Rathlev, Olshaker, Obendorfer, Mehta, Rothenhaus, Crespo, Magauran, Fisher)
    • ,
  • Supriya D. Mehta, PhD, MHS

      Affiliations

    • Departments of Emergency Medicine (Rathlev, Olshaker, Obendorfer, Mehta, Rothenhaus, Crespo, Magauran, Fisher)
    • ,
  • Todd Rothenhaus, MD

      Affiliations

    • Departments of Emergency Medicine (Rathlev, Olshaker, Obendorfer, Mehta, Rothenhaus, Crespo, Magauran, Fisher)
    • ,
  • Steven Crespo, MD

      Affiliations

    • Departments of Emergency Medicine (Rathlev, Olshaker, Obendorfer, Mehta, Rothenhaus, Crespo, Magauran, Fisher)
    • ,
  • Brendan Magauran, MD, MBA

      Affiliations

    • Departments of Emergency Medicine (Rathlev, Olshaker, Obendorfer, Mehta, Rothenhaus, Crespo, Magauran, Fisher)
    • ,
  • Kathy Davidson, MSN, MBA

      Affiliations

    • Nursing (Fisher, Guy), Senior Hospital Administration (Chessare, Davidson), Boston University Medical Center, Boston, MA
    • ,
  • Richard Shemin, MD

      Affiliations

    • Cardiothoracic Surgery (Shemin)
    • ,
  • Keith Lewis, MD

      Affiliations

    • Anesthesiology (Lewis)
    • ,
  • James M. Becker, MD

      Affiliations

    • Surgery (Becker)
    • ,
  • Linda Fisher, RN

      Affiliations

    • Departments of Emergency Medicine (Rathlev, Olshaker, Obendorfer, Mehta, Rothenhaus, Crespo, Magauran, Fisher)
    • Nursing (Fisher, Guy), Senior Hospital Administration (Chessare, Davidson), Boston University Medical Center, Boston, MA
    • ,
  • Linda Guy, RN

      Affiliations

    • Nursing (Fisher, Guy), Senior Hospital Administration (Chessare, Davidson), Boston University Medical Center, Boston, MA
    • ,
  • Abbott Cooper, MBA

      Affiliations

    • the Health Policy Institute, Boston University, Boston, MA (Cooper, Litvak)Drs. Chessare, Rothenhaus, and Crespo are currently affiliated with Caritas Christi Health Care System, Boston, MADr. Mehta is currently affiliated with the University of Illinois School of Public Health, Chicago, ILCooper is currently affiliated with Hospital Dynamics, Inc., Hampton, NH
    • ,
  • Eugene Litvak, PhD

      Affiliations

    • the Health Policy Institute, Boston University, Boston, MA (Cooper, Litvak)Drs. Chessare, Rothenhaus, and Crespo are currently affiliated with Caritas Christi Health Care System, Boston, MADr. Mehta is currently affiliated with the University of Illinois School of Public Health, Chicago, ILCooper is currently affiliated with Hospital Dynamics, Inc., Hampton, NH

,Revised 13 October 2006 ,Accepted 2 November 2006.

References 

  1. Solberg LI, Asplin BR, Weinick RM, et al. Emergency department crowding: consensus development of potential measures. Ann Emerg Med. 2003;42:824–834
  2. Asplin BR, Magid DJ, Rhodes KV, et al. A conceptual model of emergency department crowding. Ann Emerg Med. 2003;42:173–180
  3. Chan L, Reilly KM, Salluzzo RF. Variables that affect patient throughput times in an academic emergency department. Am J Med Qual. 1997;12:183–186
  4. Schull MJ, Lazier K, Vermeulen M, et al. Emergency department contributors to ambulance diversion: a quantitative analysis. Ann Emerg Med. 2003;41:467–476
  5. Olshaker JS, Rathlev NK. Emergency department crowding and ambulance diversion: the impact and potential solutions of extended boarding of admitted patients in the emergency department. J Emerg Med. 2006;30:351–356
  6. Asplin BR. Measuring crowding: time for a paradigm shift. Acad Emerg Med. 2006;13:459–461
  7. Forster AJ, Stiell IG, Wells G, et al. The effect of hospital occupancy on emergency department length of stay and patient disposition. Acad Emerg Med. 2003;10:127–133
  8. Rothenhaus TC, Stein B. An open source, intranet-based tracking system for the emergency department [abstract]. Ann Emerg Med. 2000;36:S56
  9. Nelson BK. Statistical methodology, V: time series analysis using autoregressive integrated moving average (ARIMA) models. Acad Emerg Med. 1998;5:739–744
  10. Tsay RS. Analysis of Financial Time Series. Hoboken, NJ: John Wiley & Sons, Inc; 2005;
  11. Bernstein SL, Verghese V, Leung W, et al. Development and validation of a new index to measure emergency department crowding. Acad Emerg Med. 2003;10:938–942
  12. Weiss SJ, Derlet R, Arndahl J, et al. Estimating the degree of emergency department crowding in academic medical centers: results of the National ED Crowding Study (NEDOCS). Acad Emerg Med. 2004;11:38–50
  13. Litvak E, Long MC. Cost and quality under managed care: irreconcilable differences?. Am J Manag Care. 2000;3:305–312
  14. McManus ML, Long MC, Cooper A, et al. Variability in surgical caseload and access to intensive care services. Anesthesiology. 2003;98:1491–1496
  15. McConnell KJ, Richards CF, Daya M, et al. Effect of increased ICU capacity on emergency department length of stay and ambulance diversion. Ann Emerg Med. 2004;45:471–478
  16. Cardin S, Afilalo M, Lang E, et al. Intervention to decrease emergency department crowding: does it have an effect on return visits and hospital readmission?. Ann Emerg Med. 2003;41:173–185
  17. Spaite DW, Bartholomeaux F, Guisto JM, et al. Rapid process design in a university-based emergency department: decreasing waiting time intervals and improving patient satisfaction. Ann Emerg Med. 2002;39:168–177
  18. Viccellio P. Emergency department crowding : an action plan. Acad Emerg Med. 2001;8:185–187

 Supervising editor: Brent R. Asplin, MD, MPH

 Author contributions: NKR, JC, JO, SDM, SC, BM, LF, and EL conceived the study and designed the trial. NKR, JC, JO, KD, and EL obtained the research funding. DO, SDM, TR, and AC provided statistical advice and analyzed the data. NKR, SC, BM, KD, RS, KL, JMB, LF, LG, and AC supervised the conduct of the trial and data collection. JC, DO, TR, RS, KL, JMB, and LG managed the data for analysis. All authors contributed substantively to the revision of the article. NKR drafted the article. NKR takes responsibility for the paper as a whole.

 Funding and support: This study was funded by the “Urgent Matters” Technical Assistance Grant (#048555) and Demonstration Grant (#048556) from the Robert Wood Johnson Foundation.

 Reprints not available from the authors.

PII: S0196-0644(06)02528-5

doi: 10.1016/j.annemergmed.2006.11.007

Annals of Emergency Medicine
Volume 49, Issue 3 , Pages 265-271 , March 2007

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