Average-LOS-ED - Health Quality Ontario (HQO)

INDICATOR NAME

Name

Average time patients spent (wait and treatment) in emergency department

Alternate Name

Average length of stay for patients in emergency department

INDICATOR DESCRIPTION

Description

This indicator measures the average time (hours) that patients can expect to spend in the emergency department (ED) waiting for and receiving treatment. The ED length of stay (LOS) is calculated as the average time interval between the earlier of triage date/time or registration date/time and the date/time when a patient is admitted to the hospital or discharged from the ED (non-admitted patients). A lower number is better. Provincial targets have been set for the maximum amount of time patients should spend in the ED, waiting and being treated, before being discharged or admitted to the hospital, based on clinical evidence.

HQO Reporting tool/product

Public reporting

Dimension

Timely

Type

Process

DEFINITION AND SOURCE INFORMATION

Unit of Measurement

Hours

Calculation Methods

The average time spent in ED is calculated by dividing total time spent in the ED by total number of ED visits.

Inclusion Criteria:

ED visits with a valid and known registration date/time or triage date/time and a valid and known date/time patient left the ED or disposition date/time
Admitted Patients: unscheduled emergency visits with Disposition Codes 06 - 07
Non-admitted Patients with CTAS level 1-5: unscheduled emergency visits with Disposition Codes 01, 03-05, 08-15

Exclusion Criteria:

Scheduled visits to the emergency department
ED visits with Visit Disposition 02 (Left without being seen or triaged)
Visits with both unknown/invalid registration and triage date/time OR with unknown/invalid patient left ED date/time
Negative ER LOS (i.e. the registration or triage date/time is after the date/time that the patient left ER)
Duplicate records within the same functional centre
Detailed exclusion based on the year of data:

From July 2015 onwards:
• Cases where Registration date/time and Triage date/time are both blank/unknown (9999)
• Cases where the MIS functional centre not under General Emergency Department ('713102000' '723102000' '733102000') or Urgent Care Centre ('713102500' '723102500' '733102500') - as of January 2015 data
• Duplicate cases within the same functional centre where all ED data elements have the same values except for Abstract ID number
• Cases where ED visit indicator is = "0" (i.e. scheduled ED visit)
• Cases where Patient Left ED date/time are blank/unknown (9999)
• Cases where patient has left without being seen by a physician during his/her visit (Disposition Code 02 or 03)
• Cases where EDLOS is greater than or equal to 100,000 minutes (1,666 hours)

April 2013 to June 2015:
• Cases where Registration date/time and Triage date/time are both blank/unknown (9999)
• Cases where the MIS functional centre not under General Emergency Department ('713102000' '723102000' '733102000') or Urgent Care Centre ('713102500' '723102500' '733102500') - as of January 2015 data
• Duplicate cases within the same functional centre where all ED data elements have the same values except for Abstract ID number
• Cases where ED visit indicator is = "0" (i.e. scheduled ED visit)
• Cases where Patient Left ED date/time are blank/unknown (9999)
• Cases where patient has left without being seen by a physician during his/her visit (Disposition Code 02 or 03)
• Cases where EDLOS is greater than or equal to 100,000 minutes (1,666 hours)

From FY 11/12 to FY 12/13:
• Cases where Patient Left ED Date/Time and Disposition Date/Time are both blank/unknown (9999)
• Cases where Registration Date/Time and Triage Date/Time are both blank/unknown (9999)
• Cases where patients over the age of 125 on the earlier of triage or registration date
• Duplicate cases within the same functional center where all ER data elements have the same values except for Abstract ID number
• Cases where Scheduled Visit Indicator flag is = "Y" (i.e. scheduled ED visit)
• Cases where Patient left ED date/time is unknown or blank and the Disposition Code is 06-09, 12, 14 (admitted and transferred patients)
• Cases where patient has left without being seen by a physician during his/her visit (Disposition Code 02 or 03)
• Cases where EDLOS is greater than or equal to 100,000 minutes (1,666 hours)

Numerator (short description i.e. not inclusions/exclusions)

Denominator (short description i.e. not inclusions/exclusions)

Adjustment (risk, age/sex standardization)- generalized

None

Data Source

National Ambulatory Care Reporting System (NACRS)

Data provided to HQO by

Cancer Care Ontario (CCO)

Reported Levels of comparability /stratifications (defined)

Acuity Level, Institution, Province, Time

OTHER RELEVANT INFORMATION

Caveats and Limitations

1. Scheduled visits to the ED are excluded from this analysis. 2. Patients who registered in ED but left without being seen or triaged are not included in the analysis. 3. For non-admitted patients, patients who left without seen or treatment and who left after triage and initiation of treatment are included in the analysis. 4. This indicator can also be calculated with percentiles, such as the 50th or 90th percentile. 5. Many factors can influence the indicator results, including triage level, patient population and hospital resources. 6. Depending on the acuity of the case or hospital procedures, triage may occur before registration or vice versa. Therefore, the earlier of these 2 events is used as the starting point for calculation of this indicator.