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Factors Associated With Longer Emergency Department Length of Stay for Children With Bronchiolitis: A Prospective Multicenter Study

Mansbach, Jonathan M. MD*; Clark, Sunday MPH, ScD; Barcega, Besh R.B. MD, MBA; Haddad, Haitham MD§; Camargo, Carlos A. Jr MD, DrPH

doi: 10.1097/PEC.0b013e3181b920e1
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Objectives: Emergency department (ED) length of stay (LOS) is a quality of care measure and, when prolonged, contributes to ED crowding. Bronchiolitis, a common seasonal illness of infants, provides an opportunity to examine factors affecting ED LOS.

Methods: We analyzed data from a 30-center prospective cohort study of ED patients younger than 2 years with an attending physician diagnosis of bronchiolitis to determine what factors affect LOS. Researchers conducted a structured interview and chart review.

Results: Among 1459 children enrolled, ED LOS was available for 1416 children (97%). The median ED LOS was 3.3 hours (interquartile range, 2.3-4.8 hours). Multivariate analysis demonstrated that factors significantly (P < 0.05) associated with ED LOS were larger annual ED visit volume (reference, lowest tertile [<44,134 visits], 44,134-62,420 [β = 0.74], and ≥62,421 [β = 0.63]), Hispanic race/ethnicity (reference, white race, β = 1.43), lack of primary care provider (β = 1.28), duration of symptoms of 4 to 7 days (reference, <1 day; β = 0.58), presentation of midnight to 7 am (reference, 4:00-11:59 pm; β = 1.07), decreasing lowest oxygen saturation in ED (β = 0.07), fewer number of β-agonists during the first hour (β = 0.74), unknown oral intake (reference, adequate; β = 0.69), performance of chest x-ray (β = 0.62), and hospital admission (β = 1.11).

Conclusions: In this prospective multicenter study of children younger than 2 years with bronchiolitis, multiple factors were associated with longer ED LOS. These factors suggest the following steps to help shorten ED LOS: optimizing translation services, improving primary care provider rates, enhancing overnight patient flow, forgoing chest x-rays, and developing evidence-based admission criteria.

From the *Department of Medicine, Children's Hospital Boston, Harvard Medical School, Boston, MA; †Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA; ‡Department of Emergency Medicine, Loma Linda University Medical Center, Loma Linda, CA; §Division of Emergency Medicine, Rainbow Babies Children's Hospital, Cleveland, OH; and ¶Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.

Reprints: Jonathan M. Mansbach, MD, Children's Hospital Boston, Main Clinical Bldg 9 S, 9157, Boston, MA 02115 (e-mail: jonathan.mansbach@childrens.harvard.edu).

This study was supported by the Thrasher Research Fund (Salt Lake City, UT) and an unrestricted data analysis grant from Merck (Rahway, NJ).

© 2009 Lippincott Williams & Wilkins, Inc.