28 Chapter 2 Study population We queried our institutional database for all patients who presented at the ED in 2014 (January – December). Patients admitted to the cardiac care unit were excluded, because these patients were all treated by a separate medical team under supervision of a cardiologist. Data collection The values of the variables of interest were digitally extracted out of the hospital’s electronic patient record database. Data that required clinical interpretation were collected manually. Variables Our variables of interest were the patient characteristics (i.e., age, sex, presence of cognitive impairment, polypharmacy, Charlson Age-Comorbidity Index), organizational factors (i.e., day of presentation, time of presentation, number of consultations, diagnostic interventions, therapeutic interventions, mode of presentation, method of transport, seniority of physician, assigned urgency, destination after ED visit, revisit of the ED (after index visit), and clinical factors (i.e., presenting complaint, diagnosis at ED visit, treating specialty). Definitions ED LOS was defined as time in minutes between arrival and ED discharge or hospital admission. Prolonged ED LOS was ascertained in accordance with the definition by Brouns et al [7]: i.e., LOS at the ED larger or equal to the 75th percentile of LOS at the ED. In our total study population prolonged ED LOS was calculated as >293 minutes. Time of presentation was classified as morning (7.00–11.59 h), afternoon (12.00–16.59 h), evening (17.00–23.59 h) and night (0.00– 6.59 h). Type of referral was categorized into referral by a general practitioner, practitioner of another hospital, emergency call, physician within the hospital and self-referral. Method of transport was classified as self-transport, ambulance, HEMS (Helicopter Emergency Medical Service) and other method of transport. Treating specialty at the ED was categorized into six specialties with most patients allocated (emergency physician, surgery, internal medicine, geriatrics, pulmonology, neurology). All other specialties were classified as “other specialties”. Each type of complaint was categorized into a subgroup of presenting complaints (table 1). Emergency physicians in our hospital treated all patients, referred to the ED by emergency calls, general practitioner or selfreferral, regardless of what type of presenting complaint. Our ED is 24/7 staffed with emergency physicians. Specialists of other specialties generally attend the ED on request of the emergency physician or the resident. All medical
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