27 Prolonged length of stay of older patients in the ED CHAPTER 2 Introduction The number of older patients attending the emergency department (ED) is increasing due to a growing population with a rising life expectancy [1-3]. Coping with the large number of older patients attending the ED is an international concern for emergency care staff [3]. Older patients often require more tailored care due to an atypical presentation of symptoms, multimorbidity and concomitant polypharmacy [4,5]. They also have more complex problems and need more diagnostics and consulting specialists [6]. All these factors potentially contribute to prolonged length of stay (LOS) at the ED. Prolonged LOS of older patients at the ED has been shown to be associated with a higher risk of hospitalization and adverse outcomes [5]. Identifying risk factors for a prolonged ED LOS of older patients may provide insight into possible strategies to decrease LOS of older patients at the ED. Despite the increase of older patients presenting at the ED and thereby contributing to crowding in the ED, relatively few studies have studied risk factors for a prolonged ED LOS of older patients presenting at the ED [7, 8]. Both studies being well-conducted, had an important limitation: the type of medical specialty – as an explanatory factor for prolonged LOS among older patients presenting at the ED – was not included in the analysis. This is in contrast with our experience at a level I trauma center in an urban area in the Netherlands, where we notice marked differences in ED LOS between patients treated by different specialties. The aim of this study is to identify all patient-, organizational- and clinical characteristics that may be associated with LOS of older patients at the ED. Insight into all factors contributing to prolonged LOS of older patients at the ED, could provide vital input for developing or choosing strategies to prevent prolonged LOS at the ED, thereby achieving better quality of care for older patients attending the ED. Methods and materials Study design, -setting and –participants Study design and setting This retrospective cohort study was performed at the ED of the Radboud University Medical Center (Radboudumc), an academic level I trauma center in the Netherlands, with a 650 bed capacity and an annual census of approximately 22,000 patients. The study was carried out in accordance with the regulations as governed by the Institutional Review Board of the Radboudumc and exempted from review.
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