The 4-hour target in the emergency department, in-hospital mortality, and length of hospitalization: A single center-retrospective study

Itamar Ashkenazi, Lital Gefen, Ohad Hochman, Elias Tannous

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Background: The four-hour (4 h’) rule in the emergency department (ED) is a performance-based measure introduced with the objective to improve the quality of care. We evaluated the association between time in the ED with in-hospital mortality and hospital length of stay (LOS). Methods: This was a retrospective study performed in one public hospital with over 100,000 ED referrals per year. Hospitalizations from the ED during 2017 were analyzed. We defined time in the ED as either: until a decision was made (DED); or total time in the ED (TED). In-hospital mortality and LOS were evaluated for patients with DED or TED within and beyond 4 h’. Results: Compared to patients with TED or DED within 4 h’, in-hospital mortality did not increase in patients with TED beyond 4 h’ (2.8% vs. 3.1%, non-significant), or DED beyond 4 h’ (2.1% vs. 3.2%, p < 0.001). LOS did increase in patients with either DED or TED beyond 4 h’ (p < 0.001). In-hospital mortality increased with increasing DED-TED intervals for patients hospitalized in the internal medicine departments: 3.7% (0–1 h’), 5.1% (1–2 h’), 5.7% (2–3 h’), and 7.1% (>3 h’) (p < 0.001). Conclusions: In-hospital mortality was not associated with time in the ED beyond 4 h’. LOS, however, was increased in this group of patients. Decreased LOS observed in patients with time in the ED within 4 h’, does not support patients' risk as a contributing factor leading to higher trends in mortality observed in this patient group. In-hospital mortality was associated with an increase in DED-TED intervals in patients hospitalized in the internal medicine departments.

Original languageEnglish
Pages (from-to)95-100
Number of pages6
JournalAmerican Journal of Emergency Medicine
Volume47
DOIs
StatePublished - 1 Sep 2021
Externally publishedYes

Keywords

  • Emergency department
  • Four-hour target
  • Performance measures
  • Quality of care

ASJC Scopus subject areas

  • Emergency Medicine

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