Background: It is important to assess factors contributing to ED length of stay (LOS), a key marker of emergency department (ED) throughput.Study Objectives: To evaluate whether various factors are associated with LOS; namely, patient disposition, number of lab tests, age group, type of ED, receiving a patient consult, and receiving a radiology study.Methods: A prospective, observational, multisite cohort study of a 24-hour consecutive sample of pediatric ED patients was conducted on 11/14/11 at 6 U.S. EDs: 3 children's hospitals, 3 general EDs of which 2 had separate pediatric areas, and 1 integrated adult and pediatric area.Demographic information was collected.A mixed models approach was used to model total LOS as a function of disposition (admitted or discharged), number of lab tests (none, 1 -2, > 3), age group (< 28 days, 1 month -<2 years, 2 -<5 years, 5 -<13 years, 13 -21 years), type of ED (General ED, Children's ED), receiving a patient consult (yes, no) and receiving a radiology study (yes, no).Results: A total of 641 pediatric patients were screened, with a final sample size of 628 eligible patients (6 with unknown admission/discharge status; 6 transferred, 1 with disposition decision time before admission); 67 admitted and 561 discharged.Ages ranged from 0-21 years, with a mean age of 7.54 (AE 6.12).Subjects were Caucasian (36.81%),African American (25.28%),Hispanic (22.75%),Asian (3.48%) and other/ unknown (11.58%); and 52.35% male.Most subjects arrived by private vehicle (91.63%), basic life support (5.53%) and advanced life support ambulances (2.21%).Total LOS was significantly associated with number of lab tests (P < 0.0001), patient consults (P < 0.0002) and radiology study (P < 0.0001).The effects of disposition (P < 0.0546), age group (P < 0.2051) and type of ED (P < 0.4382) were not significant.Subjects with at least one lab test had a significantly longer LOS as compared to those with no lab tests.Subjects with 1 -2 lab tests (mean 227.93 minutes, standard error (SE): 29.00) and > 3 lab tests (mean 312.61 min, SE: 29.28) stayed, on average, 23 and 107 minutes longer than subjects with no lab tests (mean 205.14 min, SE: 28.48), respectively.Subjects with a patient consult (mean 268.94 min, SE: 29.10) stayed, on average, 41 minutes longer than subjects with no patient consult (mean 228.18 min, SE: 28.19).Subjects with a radiology study (mean 270.26 min, SE: 28.39) stayed, on average, 43 minutes longer than subjects with no radiology study (mean 226.86 min, SE: 28.40).Conclusions: Patients stayed in the ED longer when they received a patient consult, radiology study, or at least one lab test, than those who did not.Focusing on addressing factors contributing to increased LOS may help improve overall patient satisfaction and care.

Length of stay (LOS) is a key marker of emergency department (ED) throughput. To describe ED LOS and various throughput metrics in admitted and discharged pediatric patients. A prospective, observational, multisite cohort study, 24-hour consecutive sample of pediatric ED patients was conducted on 11/14/11 at 6 U.S. EDs: 3 children's hospitals, 3 general EDs (2 had separate pediatric areas, and 1 integrated adult/pediatric). Demographic information and time intervals were collected. Primary outcome variables were total LOS and time interval from door to provider and disposition decision to departure. Descriptive statistics (median, first quartile (Q1) (25th percentile), third quartile (Q3) (75th percentile)) were used for time intervals overall and by disposition. A mixed model was also used to compare the mean time from disposition decision to departure. A total of 641 pediatric patients were screened, with 628 eligible patients (6 unknown admission/discharge status; 6 transferred, 1 disposition decision time before admission); 67 admitted and 561 discharged. Ages ranged from 0-21 years, mean age 7.54 (± 6.12). Subjects were Caucasian (36.81%), African-American (25.28%), Hispanic (22.75%), Asian (3.48%) and other/unknown (11.58%); and 52.35% male. Most subjects arrived by private vehicle (91.63%), Basic Life Support (5.53%) and Advanced Life Support ambulances (2.21%). Overall, the median total LOS was 163 minutes (min) (Q1 = 117, Q3 = 226). Admitted patients had a longer total LOS (median = 239 min, Q1 = 181, Q3 = 341) than discharged patients (median = 157 min, Q1 = 113, Q3 = 217). Overall, the median time from door to provider was 51 min (Q1 = 21, Q3 = 88). Discharged patients had a longer wait time from door to provider (median = 56 min, Q1 = 22, Q3 = 90) than admitted patients (median = 29 min, Q1 = 13, Q3 = 54.5) The median and mean time from admission decision to ED departure among admitted patients was 76.5 min (Q1 = 53, Q3 = 112.5) and 80.36 min (SE: 8.94) respectively (information was only available for 36 of the 67). The median and mean from discharge decision to departure was 14 min (Q1 = 9, Q3 = 23) and 10.66 (SE: 7.98), respectively for discharged patients. Admitted subjects waited, on average, 70 minutes longer from disposition decision to departure as compared to discharged (P < 0.0001). Admitted patients had a longer total LOS than discharged patients. Discharged patients had a longer wait time from door to provider as compared to admitted patients. Focusing on ways to improve the time from door to provider for lower acuity patients as well as final departure from the ED may improve overall ED LOS and patient satisfaction.

Study Objective: This study aims to evaluate if there is a correlation between the age of the child and the number of laboratory tests performed in the emergency department (ED). Studying patterns of laboratory testing on pediatric patients may help better understand factors influencing length of stay (LOS), since laboratory testing has been shown to extend ED LOS. Methods: A prospective, observational, 24-hour consecutive sample study of pediatric emergency medicine patients was conducted on November 14, 2011 at 6 U.S. emergency departments. Data was collected at 3 children's hospitals with pediatric EDs, 2 hospitals with separate pediatric areas within their EDs, and one hospital with an integrated ED that sees both adult and pediatric patients in the same area. Demographic information, mode of arrival and insurance information were collected. The frequency of main laboratory and point-of-care testing (POCT) testing was assessed. If subjects had the same test done in both the main laboratory and POCT, the test was only counted once. The relationship between subject's age and the number of tests was examined using Spearman's correlation coefficient. Results: A total of 643 subjects were enrolled. The ages ranged from 0-21 years; the mean age was 7.54 (± 6.12). The sample was 52.35% male. The subjects were white (36.81%), African-American (25.28%), Hispanic (22.75%), Asian (3.48%) and other/unknown (11.58%). Most subjects arrived by private vehicle (91.63%). Other modes of arrival included advanced life support ambulances (2.21%) and basic life support ambulances (5.53%). Managed care insurance (43.23%) was the most common payment option; other options included private insurance (26.75%), Medicaid (32.97%), self-pay (5.29%) and military insurance (3.27%). The number of laboratory tests ranged from 0-15 per subject; the majority of subjects had no laboratory tests (66.87%). There were 22 subjects with the same test conducted in the main laboratory and POCT. These tests included urinalysis, D-dimer, pregnancy test (urine), rapid strep test and “other” lab tests. There was a significant correlation between the number of laboratory tests and age (ρ = 0.2314, P < 0.0001). As age increased, the number of laboratory tests increased. Conversely, as age decreased, the number lab tests decreased. Conclusion: In the ED, older children had more laboratory tests performed than younger children. These results suggest the need for future research to look at how acuity and chief complaint may also impact the frequency of testing as well as LOS.

Exposure to high levels of environmental tobacco smoke can occur in hotels. Controversy exists about smoking regulation on licensed premises. This survey of 138 people attending one of three Newcastle hotels during 1993 found that 57 per cent of respondents were nonsmokers. Fifty-eight per cent (95 per cent confidence interval (CI) 50 to 66 per cent) of respondents in these hotels believed their health was being adversely affected by other people's smoke in the hotel. Seventy per cent (CI 62 to 78 per cent), including half the smokers, were in favour of restriction of smoking in the hotels. Most preferred the establishment of smoke-free areas to the introduction of total smoking bans in hotels. The failure of hotels to regulate smoking suggests that a legislative approach is required. The case for legislation would be strengthened by a larger study elsewhere in Australia.