Reasons for longer LOS at the emergency departments: Practical, patient‐centred, medical, or cultural?

Amir Khorram‐Manesh, Ingela Wennman, Björn Andersson, Lina Dahlén Holmqvist, Tobias Carlson and Eric Carlström

International Journal of Health Planning and Management, 2019, vol. 34, issue 4, e1586-e1596

Abstract: Emergency department (ED) overcrowding is caused by external and/or internal factors. One critical internal factor, leading to longer length of stay (LOS) at ED (eg, frequent ED users), is the physician's uncertainty in management of patients with unclear diagnosis and or complex medical history. The aim of this study was to identify whether the causes of physicians' uncertainty was practical, patient‐centred, medical, or cultural. Using earlier published dimensions of uncertainty, 18 physicians were asked to reply to a template by choosing a relevant dimension that causes a delay in assessment of a known complex patient. This stage was completed by interviews through which participants had an opportunity to express their concerns and critical thoughts, if any. The data obtained from the template were collected and analysed. The interviews were recorded and transcribed verbatim. The results of the template indicated medical dimension as the main factor in delayed assessment of a complex patient. However, this finding was challenged by the results of the interviews, which indicated higher impact of personal/routines/cultural dimension (eg, being afraid of criticism, reprimand, and gossip or feelings of guilt). Although medical, patient‐centred, and practical issues are important causes of longer LOS at ED, physicians' working and professional environment may have a higher impact than previously perceived. The uncertainty caused by interpersonal, organisational, and cultural issues within a clinic/hospital seems to influence the physician's ability to make decisions and thus a patient's medical outcome.

Date: 2019
References: View complete reference list from CitEc
Citations:

Downloads: (external link)
https://doi.org/10.1002/hpm.2849

Related works:
This item may be available elsewhere in EconPapers: Search for items with the same title.

Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text

Persistent link: https://EconPapers.repec.org/RePEc:bla:ijhplm:v:34:y:2019:i:4:p:e1586-e1596

Ordering information: This journal article can be ordered from
http://www.blackwell ... bs.asp?ref=0749-6753

Access Statistics for this article

International Journal of Health Planning and Management is currently edited by Calum Paton

More articles in International Journal of Health Planning and Management from Wiley Blackwell
Bibliographic data for series maintained by Wiley Content Delivery ().