Factors Relating to Decision Delay in the Emergency Department: Effects of Diagnostic Tests and Consultations

Abstract

Mustafa Gokalp Ataman,1 Gorkem Sariyer,2 Caner Saglam,3 Arif Karagoz,1 Erden Erol Unluer3 1Department of Emergency Medicine, Bakırçay University Çiğli Training and Research Hospital, İzmir, Turkey; 2Department of Business Administration, Yaşar University, İzmir, Turkey; 3Department of Emergency Medicine, University of Health Sciences Bozyaka Training and Research Hospital, İzmir, TurkeyCorrespondence: Mustafa Gokalp Ataman, Department of Emergency Medicine, Bakırçay University Çiğli Training and Research Hospital, 8780/1 Street No: 18 Yeni Mahalle Ata Sanayi / Çiğli, İzmir, Turkey, Tel [phone], Fax [phone], Email [email protected]: The purpose of this study is to investigate the factors increasing waiting time (WT) and length of stay (LOS) in patients, which may cause delays in decision-making in the emergency departments (ED).Patients and Methods: Patients who arrived at a training hospital in the central region of Izmir City, Turkey, during the first quarter of 2020 were retrospectively analyzed. WT and LOS were the outcome variables of the study, and gender, age, arrival type, triage level determined based on the clinical acuity, diagnosis encoded based on International Classification of Diseases-10 (ICD-10), the existence of diagnostic tests or consultation status were the identified factors. The significance of the differences in WT and LOS values based on each level of these factors was analyzed using independent sample t-tests and ANOVA.Results: While patients for which no diagnostic testing or consultation was requested had a significantly higher WT in EDs, their LOS values were substantially lower than those for which at least one diagnostic test or consultation was ordered (p≤ 0.001). Besides, elderly and red zone patients and those who arrived by ambulance had significantly lower WT and higher LOS values than other levels for all groups of patients for which laboratory-type or imaging-type diagnostic test or consultation was requested (p≤ 0.001 for each comparison).Conclusion: Besides ordering diagnostic tests or consultation in EDs, different factors may extend patients’ WT and LOS values and cause significant decision-making delays. Understanding the patient characteristics associated with longer waiting times and LOS values and, thus, delayed decisions will enable practitioners to improve operations management in EDs.Keywords: emergency department, waiting time, length of stay, delay

Keywords

• emergency department
• waiting time
• length of stay
• delay