39 Prolonged length of stay of older patients in the ED CHAPTER 2 while they only included complaints at presentation that were related to the field of internal medicine. Different types of presenting complaints may require different clinical approaches, which could justify the difference in LOS at the ED. The association that we found between a higher number of consultations and a prolonged LOS at the ED has been identified before [7, 11], and so has the association between a prolonged LOS at the ED and a higher number of diagnostic interventions [7, 12]. Our study has shown that older patients at the ED often have complex problems, which require more than one treating specialty and several consultations and diagnostic interventions to make a treatment plan at the ED. Compared to older patients who had an urgency of U0, older patients with a lower urgency category were more likely to have a prolonged LOS. This is in line with the findings of a recent study [8]. We found contrasting findings in prior published data [12, 13], but patients with the population of interest in those studies was not specified on older patients explicitly. When compared to older patients treated by an emergency physician, older patients who were treated by doctors of the departments of surgery, internal medicine or pulmonology were more likely to have a prolonged stay at the ED. However, it should be noted that patients with lower comorbiditywere treated by emergency physicians more often than by doctors of other specialisms. Patients with lower comorbidity presumably have shorter LOS at the ED. Secondly, in our ED all patients with minor trauma are treated by emergency physicians. These patients usually have presenting complaints, which can be diagnosed and treated rapidly (e.g., a patient with a wound) resulting in a short LOS at the ED. To the best of our knowledge, the association between the type of attending physician and prolonged LOS of older patients at the ED has not been identified before. The finding that the odds of a prolonged LOS may be affected by the type of treating specialty could be a reason for future research on streamlining clinical processes at the ED. The increase of older patients, who require more extensive and personalized care, challenges EDs to find solutions for the increasing LOS of these patients at the ED. Knowledge of the factors that may affect LOS can help emergency physicians to minimize the LOS of older at the ED, and may reduce the patient complication rate that goes along with a prolonged LOS at the ED [5]. Our results showed that, patients with altered consciousness or presenting complaints of neurological or internal medicine focus, are prone for prolonged LOS at the ED. Emergency physicians could be trained to enhance their knowledge and competencies in these fields, in an attempt to treat these patients in a better and timely manner and prevent prolonged LOS. Our results also showed, that patients treated by doctors of the departments of surgery, internal medicine or pulmonology were more likely to result in a prolonged LOS at the ED.
RkJQdWJsaXNoZXIy MjY0ODMw