Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Jun;95(26):e4053.
doi: 10.1097/MD.0000000000004053.

Predictive Factors for Hospitalization of Nonurgent Patients in the Emergency Department

Affiliations
Free PMC article

Predictive Factors for Hospitalization of Nonurgent Patients in the Emergency Department

Chip-Jin Ng et al. Medicine (Baltimore). .
Free PMC article

Abstract

Nonurgent emergency department (ED) patients are a controversial issue in the era of ED overcrowding. However, a substantial number of post-ED hospitalizations were found, which prompted for investigation and strategy management. The objective of this study is to identify risk factors for predicting the subsequent hospitalization of nonurgent emergency patients. This was a retrospective study of a database of adult nontrauma ED visits in a medical center for a period of 12 months from January 2013 to December 2013. Patient triages as either Taiwan Triage and Acuity Scale (TTAS) level 4 or 5 were considered "nonurgent." Basic demographic data, primary and secondary diagnoses, clinical parameters including blood pressure, heart rate, body temperature, and chief complaint category in TTAS were analyzed to determine if correlation exists between potential predictors and hospitalization in nonurgent patients.A total of 16,499 nonurgent patients were included for study. The overall hospitalization rate was 12.47 % (2058/16,499). In the multiple logistic regression model, patients with characteristics of males (odds ratio, OR = 1.37), age more than 65 years old (OR = 1.56), arrival by ambulance (OR = 2.40), heart rate more than 100/min (OR = 1.47), fever (OR = 2.73), and presented with skin swelling/redness (OR = 4.64) were predictors for hospitalization. The area under receiver-operator calibration curve (AUROC) for the prediction model was 0.70. Nonurgent patients might still be admitted for further care especially in male, the elderly, with more secondary diagnoses, abnormal vital signs, and presented with dermatologic complaints. Using the TTAS acuity level to identify patients for diversion away from the ED is unsafe and will lead to inappropriate refusal of care for many patients requiring hospital treatment.

Conflict of interest statement

The authors report no conflicts of interest.

Figures

Figure 1
Figure 1
The predictability of score combining factors derived from multiple logistic regression to hospitalization (AUROC = 0.70).

Similar articles

See all similar articles

Cited by 4 articles

References

    1. Afilalo J, Marinovich A, Afilalo M, et al. Nonurgent emergency department patient characteristics and barriers to primary care. Acad Emerg Med 2004; 11:1302–1310. - PubMed
    1. Durand AC, Gentile S, Devictor B, et al. ED patients: how nonurgent are they? Systematic review of the emergency medicine literature. Am J Emerg Med 2011; 29:333–345. - PubMed
    1. FitzGerald G, Jelinek GA, Scott D, et al. Emergency department triage revisited. Emerg Med J 2009; 27:86–92. - PubMed
    1. Hoot NR, Aronsky D. Systematic review of emergency department crowding: causes, effects, and solutions. Ann Emerg Med 2008; 52:126–136. - PubMed
    1. Cunningham PJ, Clancy CM, Cohen JW, et al. The use of hospital emergency departments for nonurgent health problems: a national perspective. Med Care Res Rev 1995; 52:453–474. - PubMed
Feedback