Influences on Emergency Department length of stay for older people

Prof. Julie Considine1, Ms Debra Berry2, Dr Anthony Cross3, Dr  Mohammadreza Mohebbi4, Dr Maryann  Street1

1Deakin University, School of Nursing and Midwifery and Centre for Quality and Patient Safety Research (QPS) /  QPS – Eastern Health Partnership , Geelong, Australia, 2Deakin University, School of Nursing and Midwifery /  QPS – Eastern Health Partnership , Geelong, Australia, 3Northern Health, Epping, Australia, 4Deakin University, Biostatistics Unit, Faculty of Health, Geelong, Australia

Background: Older people have longer emergency department length of stay (EDLOS) and higher hospital admission rates. Longer EDLOS is associated with increased length of hospital stay and in-hospital mortality. The aim of this study was to examine the influences on EDLOS for older people (≥65 years) and develop a predictive model for an EDLOS>4-hours.

Methods: This retrospective cohort study linked organisational data at the patient level. The study population were aged ≥65 years, attending one of three EDs at a major Australian health service during 2013/2014 financial year. A clinical prediction rule was developed and internally validated using multivariate logistic regression and evaluated using receiver operating characteristic (ROC) analysis.

Results: Of 33,926 ED attendances, 57.5% (n=19,517) had an EDLOS >4-hours. Factors associated with EDLOS >4-hours were prolonged time to medical assessment, ED overcrowding and access block, age >75 years, ED pathology testing or diagnostic imaging, ≥3 ED attendances resulting in hospital admissions, living in residential aged care, ED arrival overnight or by ambulance, triage category 3 or 4. The areas under ROC were 0.796 (derivation) and 0.80 (validation). The risk score assigned to each factor ranged from 2 to 68 points based on  coefficients. The clinical prediction rule stratified patients into five levels of risk.

Conclusions: Objective identification of older people at risk of EDLOS >4-hours early in their ED episode of care enables targeted approaches to streamline the patient journey, decrease EDLOS and optimise emergency care for older people.

Implications: Patient, clinical and organisational factors were strongly predictive of ED LOS for older individuals. Providing timely, safe and quality ED care for older patients has clear benefits for patients and their families, but will also improve ED and health service access for other patient groups.


Julie is Deakin University’s Chair in Nursing at Eastern Heath in Melbourne. She has held clinical, education and research roles in emergency nursing over the last two decades and internationally recognised as a leader in research and education in emergency care. Julie has over 150 publications and has attracted over $5.2M in research and project funding. She is a Founding Fellow of the College of Emergency Nursing Australasia (CENA), Deputy Editor of the Australasian Emergency Nursing Journal, represents the College of Emergency Nursing Australasia on the Australian Resuscitation Council.