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Australian Health Review Australian Health Review Society
Journal of the Australian Healthcare & Hospitals Association
RESEARCH ARTICLE

Admission time to hospital: a varying standard for a critical definition for admissions to an intensive care unit from the emergency department

Shane Nanayakkara A E , Heike Weiss A , Michael Bailey B , Allison van Lint C , Peter Cameron D and David Pilcher A B C
+ Author Affiliations
- Author Affiliations

A Department of Intensive Care, The Alfred Hospital, PO Box 315, Prahran, Vic. 3181, Australia. Email: d.pilcher@alfred.org.au; heike.weiss@gmail.com

B Australian and New Zealand Intensive Care – Research Centre, Department of Epidemiology and Preventive Medicine, Monash Univeristy, Commercial Road, Prahran, Vic. 3004, Australia. Email: michael.bailey@monash.edu

C Australian and New Zealand Intensive Care Society, Centre for Outcome and Resource Evaluation, PO Box 164 Carlton South, Vic. 3053, Australia. Email: allison.vanlint@anzics.com.au

D Department of Emergency Medicine, The Alfred Hospital, PO Box 315, Prahran, Vic. 3181, Australia. Email: peter.cameron@monash.edu

E Corresponding author. Email: s.nanayakkara@alfred.org.au

Australian Health Review 38(5) 575-579 https://doi.org/10.1071/AH13244
Submitted: 5 February 2014  Accepted: 28 July 2014   Published: 5 November 2014

Abstract

Objective Time spent in the emergency department (ED) before admission to hospital is often considered an important key performance indicator (KPI). Throughout Australia and New Zealand, there is no standard definition of ‘time of admission’ for patients admitted through the ED. By using data submitted to the Australian and New Zealand Intensive Care Society Adult Patient Database, the aim was to determine the differing methods used to define hospital admission time and assess how these impact on the calculation of time spent in the ED before admission to an intensive care unit (ICU).

Methods Between March and December of 2010, 61 hospitals were contacted directly. Decision methods for determining time of admission to the ED were matched to 67 787 patient records. Univariate and multivariate analyses were conducted to assess the relationship between decision method and the reported time spent in the ED.

Results Four mechanisms of recording time of admission were identified, with time of triage being the most common (28/61 hospitals). Reported median time spent in the ED varied from 2.5 (IQR 0.83–5.35) to 5.1 h (2.82–8.68), depending on the decision method. After adjusting for illness severity, hospital type and location, decision method remained a significant factor in determining measurement of ED length of stay.

Conclusions Different methods are used in Australia and New Zealand to define admission time to hospital. Professional bodies, hospitals and jurisdictions should ensure standardisation of definitions for appropriate interpretation of KPIs as well as for the interpretation of studies assessing the impact of admission time to ICU from the ED.

What is known about the topic? There are standards for the maximum time spent in the ED internationally, but these standards vary greatly across Australia. The definition of such a standard is critically important not only to patient care, but also in the assessment of hospital outcomes. Key performance indicators rely on quality data to improve decision-making.

What does this paper add? This paper quantifies the variability of times measured and analyses why the variability exists. It also discusses the impact of this variability on assessment of outcomes and provides suggestions to improve standardisation.

What are the implications for practitioners? This paper provides a clearer view on standards regarding length of stay in the ICU, highlighting the importance of key performance indicators, as well as the quality of data that underlies them. This will lead to significant changes in the way we standardise and interpret data regarding length of stay.


References

[1]  Department of Health and Ageing. Victorian emergency minimum dataset user manual. Victoria 2010–11. Victorian Government: Melbourne; 2011.

[2]  Chalfin DB, Trzeciak S, Likourezos A, Baumann BM, Dellinger RP. Impact of delayed transfer of critically ill patients from the emergency department to the intensive care unit. Crit Care Med 2007; 35 1477–83.
Impact of delayed transfer of critically ill patients from the emergency department to the intensive care unit.Crossref | GoogleScholarGoogle Scholar | 17440421PubMed |

[3]  Carter AW, Pilcher D, Bailey M, Cameron P, Duke GJ, Cooper J. Is ED length of stay before ICU admission related to patient mortality? Emerg Med Australas 2010; 22 145–50.
Is ED length of stay before ICU admission related to patient mortality?Crossref | GoogleScholarGoogle Scholar | 20534049PubMed |

[4]  Secretary of State for Health. The NHS plan. Norwich: Department of Health; 2000.

[5]  Department of Health and Ageing. Four hour national target. 2011 [cited 2011 June].

[6]  Stow PJ, Hart GK, Higlett T, George C, Herkes R, McWilliam D, Bellomo R. Development and implementation of a high-quality clinical database: the Australian and New Zealand Intensive Care Society Adult Patient Database. J Crit Care 2006; 21 133–41.
Development and implementation of a high-quality clinical database: the Australian and New Zealand Intensive Care Society Adult Patient Database.Crossref | GoogleScholarGoogle Scholar | 16769456PubMed |

[7]  Australasian College for Emergency Medicine (ACEM). Policy on the definition of an admission. West Melbourne: ACEM; 2006 Available at: http://www.acem.org.au/media/policies_and_guidelines/P46_Definition_of_an_admission.pdf [verified June 2013].

[8]  ANZICS Centre for Outcome and Resource Evaluation. ANZICS CORE 2010 annual report. Melbourne: ANZICS Centre for Outcome and Resource Evaluation; 2010.

[9]  Adult Patient Database Data Dictionary. 2010 Adult patient database data dictionary. Melbourne: ANZICS; 2010.

[10]  Bureau of Health Information. Technical supplement: measures of emergency department performance and activity. Sydney: Australian Government; 2010.

[11]  Liew D, Liew D, Kennedy M. Emergency department length of stay independently predicts excess inpatient length of stay. Med J Aust 2003; 179 524–6.
| 14609414PubMed |

[12]  Mitra B, Cameron PA, Archer P, Bailey M, Pielage P, Mele G, Smit D, Newnham H. The association between time to disposition plan in the emergency department and in-hospital mortality of general medical patients. Intern Med J 2012; 42 444–50.
The association between time to disposition plan in the emergency department and in-hospital mortality of general medical patients.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC38zjvFyjtQ%3D%3D&md5=3c5834bb853f39acb14c2b880ca6577dCAS | 21470357PubMed |

[13]  Asadollahi K, Hastings IM, Gill GV, Beeching NJ. Prediction of hospital mortality from admission laboratory data and patient age: a simple model. Emerg Med Australas 2011; 23 354–63.
Prediction of hospital mortality from admission laboratory data and patient age: a simple model.Crossref | GoogleScholarGoogle Scholar | 21668723PubMed |

[14]  Guly H, Higginson I. Obituary for the four-hour target. Emerg Med J 2011; 28 179–80.
Obituary for the four-hour target.Crossref | GoogleScholarGoogle Scholar | 21076054PubMed |

[15]  Lansley A. Abolition of the four-hour waiting standard in Accident and Emergency. 2010.

[16]  Forero R, McDonnell G. Lessons from the 4-hour standard in England for Australia. Med J Aust 2011; 194 268
| 21382006PubMed |

[17]  Cameron PA, Schull MJ, Cooke MW. A framework for measuring quality in the emergency department. Emerg Med J 2011; 28 735–40.
A framework for measuring quality in the emergency department.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC3MjnsVOltA%3D%3D&md5=2f202bfe779cd2ef6920d45df1905232CAS | 21450757PubMed |

[18]  Australian Government. Expert panel: review of elective surgery and emergency access targets under the national partnership agreement on improving public hospital services- section 3. National Health Reform. Canberra: Australian Government; 2011.