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Cited by 117Emergency and Acute Care StudiesClinical Laboratory Practices and Quality ControlHealthcare Operations and Scheduling Optimization

The Effect of Laboratory Testing on Emergency Department Length of Stay: A Multihospital Longitudinal Study Applying a Cross‐classified Random‐effect Modeling Approach

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Li, Ling, Georgiou, Andrew, Vecellio, Elia, Eigenstetter, Alex, Toouli, George, Wilson, Roger, Westbrook, Johanna I.·2015·Academic Emergency Medicine
DOI 10.1111/acem.12565PMC PMC6680199
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Abstract

Objectives: The objective was to examine the relationship between laboratory testing (including test volume and turnaround time [ TAT ]) and emergency department ( ED ) length of stay ( LOS ), using linked patient‐level data from four hospitals across 4 years. Methods: This was a retrospective, multisite cohort study of patients presenting to any one of four ED s in New South Wales, Australia, during a 2‐month period (August and September) in 2008, 2009, 2010, and 2011. Data from ED information systems were linked to laboratory test data. A cross‐classified random‐effect modeling approach was applied to identify factors affecting ED LOS , taking into account the correlation between patients' presentations at the same hospital and/or in the same calendar year. Number of test order episodes (tests ordered at one point in time during the ED stay) and TAT (time from laboratory order receipt to result available) were examined. Results: As the number of test order episodes increased, so did the duration of patient ED LOS (p < 0.0001). For every five additional tests ordered per test order episode, the median ED LOS increased by 10 minutes (2.9%, p < 0.0001); each 30‐minute increase in TAT was, on average, associated with a 5.1% (17 minutes; p < 0.0001) increase in ED LOS , after adjustment for other factors. Patients presenting to the ED at night (7 p.m. to 7 a.m.) had longer stays than those presenting during the daytime, although the median TAT s at nights were shorter than those during the daytime. Conclusions: Laboratory testing has a direct effect on patients' LOS in ED . Laboratory TAT , number of testing episodes, and test volume influence ED LOS . Targeted increases of ED resources and staffing after‐hours may also contribute to reductions in ED LOS .

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  • Emergency Severity Index level, specialty, destination after ED visit, and number of out-of-range tests were included as proxies for acuity level, which was identified as a confounder in previous studies.

    “The Emergency Severity Index level, the specialty, the destination after the ED visit and the number of out-of-range tests were included as proxies for the acuity level, which was identified as a confounder in previous studies [11, 12].”

    From Shorter laboratory turnaround time is associated with shorter emergency department length of stay: a retrospective cohort study (2022) · cites this paper as [12]

    The Methods (Data Analysis; page unavailable) include triage category and ED mode of separation as covariates, and the Discussion reports that both affect ED length of stay. These correspond broadly to acuity and destination after the ED visit. The paper does not identify acuity explicitly as a confounder or support the specific use of Emergency Severity Index level, specialty, and number of out-of-range tests as proxies. (LLM, conf=0.83)

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  1. [23]Institute of Medicine. Committee on the Future of Emergency Care in the United States Health System. Hospital‐based Emergency Care: At the Breaking Point. Washington DC: National Academies Press, 2007.

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Authors
Li, L., Georgiou, A., Vecellio, E., Eigenstetter, A., Toouli, G., Wilson, R., & Westbrook, J. I.
Affiliations
  • UNSW Sydney (AU)
  • Prince of Wales Hospital (AU)
Corresponding author
Li, Ling
ORCID
Venue
Academic Emergency Medicine
Publisher
Wiley
Published
2015-01
Volume
22
Issue
1
Pages
38-46
ISSN
  • 1069-6563 (ISSN-L)
  • 1553-2712
DOI
10.1111/acem.12565
PMC
PMC6680199
OpenAlex
W1970955942
Cited by
117
References
30
Citations by year
2026: 9 · 2025: 8 · 2024: 12 · 2023: 13 · 2022: 8 · 2021: 16 · 2020: 16 · 2019: 10 · 2018: 12 · 2017: 7 · 2016: 5 · 2015: 1
FWCI
8.11
Type
journal article
Language
en
Open access
Licence
Locations
  • Academic Emergency Medicine (publishedVersion, cc-by-nc-nd)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
Funders
Australian Government Department of Health: Quality Use of Pathology Program grant
Topics
  • Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
  • Health Sciences › Medicine › Physiology › Clinical Laboratory Practices and Quality Control
  • Health Sciences › Health Professions › Emergency Medical Services › Healthcare Operations and Scheduling Optimization
Keywords
emergency department length of stay, laboratory testing, turnaround time, test volume, hospital resource utilization
MeSH terms
Adult, Age Factors, Aged, Emergency Service, Hospital, Female, Humans, Laboratories, Hospital, Length of Stay, Longitudinal Studies, Male, Middle Aged, New South Wales, Retrospective Studies, Sex Factors, Time Factors, Triage, Diagnostic Techniques and Procedures

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