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

Journal article
Authors Amir Khorram-Manesh
Ingela Wennman
Björn Andersson
Lina Dahlén Holmqvist
Tobias Carlson
Eric Carlström
Published in International Journal of Health Planning and Management
Volume 34
Issue 4
Pages e1586-e1596
ISSN 0749-6753
Publication year 2020
Published at Institute of Clinical Sciences, Department of Surgery
Institute of Health and Care Sciences
Institute of Medicine, Department of Internal Medicine and Clinical Nutrition
Institute of Medicine, Department of Molecular and Clinical Medicine
Pages e1586-e1596
Language en
Keywords decision making, length of stay, longer waiting times, medical history, uncertainty
Subject categories Clinical Medicine


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.

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