Introduction
In present-day healthcare systems, extended stays in the emergency department (ED) have become increasingly common, with EDs facing issues of overcrowding, patient flow, and resource allocation. A study by Andersson et al. (2020) examined how patients remained in the ED for long before they could obtain essential care, which, according to the authors, occurred during admission or discharge. The knowledge about lengthy ED stays is a vital step for medical facilities to strive to provide prompt and effective emergency care (Andersson et al., 2020). Thus, this analysis, employing the Walker and Avant approach, aims to examine the complex aspects of extended ED length of stay.
Selecting a Concept
The concept of extended stays in the ED is being analyzed. It is fundamental and timely, reflecting the extended periods patients spend in EDs across healthcare settings. It has significant implications for healthcare organizations, patient outcomes, and the allocation of resources. The rationale for this concept is that extended stays in the ED are a significant issue with modern healthcare systems. It is the time a patient spends in the ED waiting for admission to the hospital or discharge.
Definitions
The healthcare management description of the concept is when a patient’s time spent in an emergency room exceeds a defined threshold and becomes a prolonged stay. It can happen due to an increased number of patients, limited resources, or delays in the care process. On the other hand, the patient’s perspective explains the concept as if they are in the emergency room, waiting a long time, and receiving no insight from the doctor. They ask about when they will be seen, but only get vague answers. Therefore, such discomforts lead to dissatisfaction and, eventually, adverse health outcomes.
Determining the Aims of the Concept
The aim of doing this concept analysis on long lengths of stay in the ED is to attain a deep understanding of this phenomenon. First, this analysis aims to define the concept by describing its meaning within the context of the ED (Andersson et al., 2020).
Second, identifying causes and contributing factors that result in prolonged stay in the ED. It may comprise factors such as external influences, care processes, resource availability, and patient acuity. Third, understanding the extreme consequences of extended ED stays, both for individual patients and the entire healthcare system (Otto et al., 2022). Finally, exploring mitigation strategies that can be employed to ease the adverse effects of long ED stays.
Nursing Literature
The concept of extended length of stay in the ED is generally discussed and used in articles related to emergency medicine. For instance, Kelen et al. (2021) examine the long length of stay in relation to ED crowding, which is a sign of strain on the healthcare system. The author concludes that extended stays pose a significant challenge to healthcare as a whole, which can negatively impact patient care and outcomes. Mohr et al. (2020) explore critically ill patients who are left in the ED for too long, potentially due to prolonged stays. The author reveals that this affects the outcome for patients and the use of resources.
In addition, Zhang et al. (2020) investigate racial disparities in ED care. The article takes a look at possible connections between ethnicity and long ED stays. The author discusses the potential effects on care and highlights the need for fair solutions.
Another article by McKenna et al. (2019) dives into the consequences and causes of crowded EDs, with extended stays being a critical component. The author discusses potential solutions to address this widespread issue. Finally, Song et al. (2020) discuss the effects of extended stays in EDs on healthcare workers, including stress and burnout. The article examines the impact of these prolonged stays on patient outcomes, the strain on the healthcare system, and the well-being of healthcare professionals.
Literature from Other Disciplines
In the world of healthcare operation management, this concept is a critical part of analyzing the efficiency of a hospital’s surgical intake capacity. It is common to hear that extended ED stays are a bottleneck that disrupts the flow for patients and affects how resources are utilized in the hospital (Heydari et al., 2022). Heydari et al. (2022) explore ways to reduce these extended stays, ultimately improving operational efficiency. Whether it is due to operational changes or disaster management, it can be used as a way to determine if they have had an impact on healthcare delivery. The book “Predictors of a long length of stay in the ED for older people” by Sweeney et al. (2020) describes a serious issue for elderly patients. The concept identifies factors that help foresee extended stays in the ED, which aid in better healthcare management for this demographic.
Identifying All Possible Uses of the Concept
The practice of extended time spent in the ED serves various critical purposes within the realm of healthcare and emergency medicine. First, it aids in identifying factors contributing to a long ED length of stay (Otto et al., 2022). Second, understanding how long ED stays affects patient health outcomes is crucial (Otto et al., 2022).
Third, the concepts facilitate the creation of interventions to reduce extended stays in the ED. Finally, it examines the impact of extended stays in the ED on the healthcare system (Otto et al., 2022). Essentially, the concept serves as a vital tool for researchers, healthcare professionals, and administrators in making critical medical decisions.
Nonetheless, it is essential to realize that the concept can be misused. For instance, equating an extended stay in the ED with inadequate care is not right. The reason behind extended stays is often a result of patient needs being too complex or a lack of resources. Therefore, stigmatizing longer stays will only hinder progress toward finding practical solutions for healthcare challenges and not address their root cause.
Determining the Defining Attributes
Duration of Stay Beyond a Defined Threshold
Attributes are vital characteristics that help define and present the concept of extended stays in the ED. The defining attribute here is that a patient stayed for longer than they should have. In some cases, even past what is acceptable or reasonable (Andersson et al., 2020). It varies between hospitals and clinical guidelines, but always represents a prolonged period.
Delay in Necessary Medical Care
Extended ED stays involve delays in the provision of essential medical care and treatment to the patient. Several issues contribute to these delays, including waiting for test results, consulting with doctors, or attempting to find a bed for admission (Andersson et al., 2020). Two main factors contribute to these delays: first, the severity of the patient’s condition. Second is resource availability, where the healthcare facility lacks the necessary resources to reduce this extended stay.
Theoretical and Operational Definitions and Measurements
Theoretically, the concept can be defined as a stay in the ED for an unnecessary amount of time. On the other hand, operational definition refers to a stay exceeding four hours in the ED from patient admission to discharge or transfer. The best way to measure this concept is by quantifying the duration of their presence. One can also determine this by examining patient satisfaction surveys, where lower scores indicate dissatisfaction with wait times.
Identifying a Model Case
The concept of a lengthened emergency department stay is shown through model cases. For instance, a patient arrives in the emergency room for a non-serious condition, such as a moderate ankle sprain (Otto et al., 2022). They arrive during high-traffic hours, when it is overcrowded and busy. Even though the injury is not urgent, they still have to stay there for 10 hours (Otto et al., 2022). The wait is mainly due to a common reason that affects hospitals: overcrowding. Therefore, it serves as a clear and illustrative model of the concept in its purest form.
Identifying Borderline, Related, Contrary, Invented, and Illegitimate Cases
Borderline Case
A borderline case involves a patient who spends time in the ED but does not meet the threshold typically considered “long.” For example, a patient with a minor injury spends more time than the standard wait time and experiences fewer delays in care.
Related Case
A related case involves a patient with an extended ED stay, although the reasons for the longer stay are unique. For instance, a patient who experiences difficulties in communication because of the language barrier and requires interpretation services might experience a longer ED stay.
Contrary Case
The contrary case represents a situation where a patient’s ED stay is remarkably short, thus contradicting the concept. It could be an individual who experiences a minor ailment and receives prompt evaluation and treatment, resulting in a brief ED visit.
Invented Case
An invented case is a hypothetical condition created to explore the possible differences between the concepts. For example, an invented case might involve a patient who experiences a prolonged ED stay because of a combination of resources, patient complexity, and care process inefficiencies.
Illegitimate Case
An illegitimate case would be a situation that entirely deviated from the idea of a prolonged stay in the emergency department. For instance, in a patient who arrives at the ED, immediate care is provided, and the patient is discharged within a reasonable period, without experiencing any delays or extended stay.
Identifying Antecedents and Consequences
Antecedents
One thing alone is enough to send the ED into chaos, while all four combined can be catastrophic. The first is that a large influx of people can cause a backlog, making it difficult for healthcare professionals to keep up with each case, which in turn leads to more extended stays. The second is limited resources, where a lack of sufficient beds, support services, diagnostic equipment, and staff makes everyone’s job a lot harder. Third is the presence of complex medical conditions, where patients with serious problems often require an extended stay due to the need for extensive tests and treatment. Lastly, there are insufficient processes that hinder the smooth flow of activities when getting someone through the ED; however, delays in treatment only exacerbate the situation.
Consequences
Longer stays in the emergency department result in patient dissatisfaction. Additionally, the longer one waits, the more likely their condition will worsen (Andersson et al., 2020). Overcrowding makes it harder to deliver care due to the large number of patients, and those in need are forced to wait even longer. These three consequences are crucial for understanding and addressing prolonged ED stays (Andersson et al., 2020). Hence, doing so will elevate patient care and satisfaction while also enhancing the healthcare system as a whole.
Defining Empirical Referents
Empirical referents are indicators that can be measured and touched, which provide solid evidence linked to the concept of extended length of stay in the ED. These referents can be used in real-life settings to gain a better understanding of the concept, which is quite helpful (Andersson et al., 2020). The first is a specific duration threshold, which defines what constitutes an extended stay, such as exceeding four hours (Andersson et al., 2020). Second, patient satisfaction scores, which involve the use of surveys and feedback, help measure how extended stays affect patients’ perceptions of quality care (Andersson et al., 2020). Finally, there is resource and data availability, which includes data on available resources and their usage in the ED.
Conclusion
In conclusion, the analysis of extended stays in the ED has highlighted the complexity of this issue in healthcare. It can lead to dissatisfaction, delayed care, overcrowding, and adverse health outcomes. It is also essential to understand key factors such as increased patient volume, limited resources, and complex medical conditions in the process of developing effective solutions. The concept analysis has also revealed the benefits of having tools for measurement and assessment, such as specific durations or patient satisfaction scores. Ultimately, the analysis serves as a means to enhance the delivery of healthcare services in the ED by optimizing systems and processes.
References
Andersson, J., Nordgren, L., Cheng, I., Nilsson, U., & Kurland, L. (2020). Long emergency department length of stay: A concept analysis. International Emergency Nursing, 53, 100930.
Heydari, M., Lai, K. K., Fan, Y., & Li, X. (2022). A review of emergency and disaster management in the process of healthcare operation management for improving hospital surgical intake capacity. Mathematics, 10(15), 2784.
Kelen, G. D., Wolfe, R., D’Onofrio, G., Mills, A. M., Diercks, D., Stern, S. A., & Sokolove, P. E. (2021). Emergency department crowding: The canary in the health care system. NEJM Catalyst Innovations in Care Delivery, 2(5).
McKenna, P., Heslin, S. M., Viccellio, P., Mallon, W. K., Hernandez, C., & Morley, E. J. (2019). Emergency department and hospital crowding: Causes, consequences, and cures. Clinical and Experimental Emergency Medicine, 6(3), 189.
Mohr, N. M., Wessman, B. T., Bassin, B., Elie-Turenne, M. C., Ellender, T., Emlet, L. L., & Rudy, S. (2020). Boarding of critically ill patients in the emergency department. Critical Care Medicine, 48(8), 1180-1187.
Otto, R., Blaschke, S., Schirrmeister, W., Drynda, S., Walcher, F., & Greiner, F. (2022). Length of stay as a quality indicator in emergency departments: Analysis of determinants in the German Emergency Department Data Registry (AKTIN registry). Internal and Emergency Medicine, 17(4), 1199-1209.
Song, X., Fu, W., Liu, X., Luo, Z., Wang, R., Zhou, N., & Lv, C. (2020). Mental health status of medical staff in emergency departments during the Coronavirus disease 2019 epidemic in China. Brain, Behavior, And Immunity, 88, 60-65.
Zhang, X., Carabello, M., Hill, T., Bell, S. A., Stephenson, R., & Mahajan, P. (2020). Trends of racial/ethnic differences in emergency department care outcomes among adults in the United States from 2005 to 2016. Frontiers in Medicine, 7, 300.