Online Poster Portal

Background/Objectives:

Hospital capacity and throughput are well known determinants of emergency department (ED) boarding and efforts are continually explored to reduce hospital length of stay (LOS). There is evidence that timing-related factors such as weather conditions, seasonality, or day of week, can also influence ED volume and admissions rates. In this study, we sought to further characterize the effect of holidays and local extreme weather events on patient discharge decisions, to see if the anticipation of these events affects patient LOS.

Methods:

This was a retrospective observational study of two hospitals within one health system between January 1st 2018 and May 31st 2022. Patient encounter data included throughput timestamps, campus census at time of discharge, and demographic information. We compiled a list of dates hypothesized to accelerate a tendency towards discharge, including federal holidays, scheduled events causing known road closures around the city of New Haven, severe weather events flagged by the National Weather Service, and Connecticut-issued statewide alerts for various emergencies. The primary outcome studied was inpatient LOS. The secondary outcome was re-presentation to the ED within 30 days. We performed linear (for inpatient LOS) and logistic (for 30-day re-presentation) regression to probe the effect of our dates of interest on these outcomes.

Results:

351,477 inpatient encounters were included in our analysis. After controlling for demographic factors, insurance type, day of week, hospital census, and the Rothman Index for patient acuity, inpatient LOS was significantly shorter for patients discharged on days approaching the special dates of interest (95% CI, [0.0014, 0.0058]; p = 0.0013). Further analysis indicates that this effect on LOS is primarily driven by increased discharges that occur on the special date itself (95% CI, [-0.3598, -0.1187]; p = 0.0001). For the re-presentation analysis, patients that were a re-encounter within 30 days were excluded to prevent double counting. Increased likelihood of returning to the ED within 30 days was significantly correlated to previous discharge on a special day (95% CI, [0.0138, 0.0899]; p = 0.0075).

Conclusion:

Local events (extreme weather, holidays, significant road closures) are associated with shorter inpatient LOS, driven by increased discharges on these dates. This effect results in increased future bouncebacks to the ED.