Effect of prolonged emergency department length of stay on inpatient length of stay and inhospital mortality in severe sepsis and septic shock

Introduction

With overcrowding in our emergency departments and an access block issue, the emergency department (ED) length of stay (LOS) is becoming a growing concern. Over the past decade, despite decreasing mortality in sepsis and septic shock in Australia and NZ hospitals, the reported incidence of sepsis and septic shock in ICU patients presenting to the ED has increased. In this study we postulated that, in severe sepsis and septic shock patients, prolonged ED LOS is associated with increased ICU and hospital LOS as well as increased inhospital mortality.

Methods

A retrospective observational study. Data were collected from 1 July 2004 to 31 October 2007. The setting was a cosmopolitan 360-bed teaching hospital with a nine-bed general ICU. The ED has 50,000 presentations per year.

Results

There were 120 patients with diagnosis of severe sepsis and septic shock admitted to the ICU. They were equally distributed males and females with a mean age of 64.75 years. We excluded three patients due to incomplete data. The mean ED LOS was 10.05 hours and the median was 8.33 hours. The mean ICU LOS and hospital LOS were 5.54 and 15.02 days, respectively. Twenty-six patients (22.2%) died in the hospital. Based on ED LOS, the patients were divided into three groups of <6 hours, 6–8 hours and >10 hours. There was no association between ED LOS and inhospital mortality (P = 0.23) between the three groups. Similarly, no association was found between ED LOS and ICU LOS or hospital LOS (P = 0.31 and P = 0.28, respectively). Gender, age and SAP score did not affect outcomes. However, a significant association was found between APACHE II score and ICU LOS (P = 0.009), with no effect on hospital LOS or mortality.

Conclusion

Our study showed that, in the severe sepsis and septic shock patient group, a prolonged ED LOS had no effect on ICU and hospital LOS or on inhospital mortality.