Analyzing Factors Affecting Length of Emergency Department Stay in Patients With Hemophilia

OBJECTIVES: Prolonged stays in the emergency department (ED) adversely affect patient health outcomes and are associated with higher mortality rates. This study aimed to assess demographic, clinical, and health system factors associated with ED length of stay (LOS) in patients with hemophilia, who often experience medical emergencies related to bleeding and present challenges in diagnosis due to the rarity of the condition.

METHODS: A retrospective analysis of electronic health records from University of Florida Health Physicians (UFHP) practice sites was conducted, including all patients (adults and pediatrics) with hemophilia visiting the ED from January 2018 to November 2023. Accelerated Failure Time model computed the Time Ratios (TRs) for ED LOS, where a TR greater than 1 indicates a longer stay, and a TR less than 1 indicates a shorter stay. We used forward selection to determine covariates to be included. Analyzed covariates included age, sex, race, bleeding event, type of hemophilia, day of ED arrival, and hematology consultation.

RESULTS: The study included ED visits from 141 patients (27F, 114 M) with a mean±SD age of 34.7±22.5. The mean±SD ED LOS for discharged patients and patients admitted are 4.5±3.8 hours and 9.2±6.5 hours, respectively. Results showed that weekend visits (compared to weekdays, TR = 1.37, 95% CI [1.01, 1.86) are associated with longer ED stays. Age ≥18 years (compared to <18 years, TR = 0.63, 95% CI [0.44, 0.91]), Hemophilia B diagnosis (compared to hemophilia A, TR = 0.69, 95% CI [0.51, 0.93]), and receiving a hematology consultation were associated with shorter stays (TR = 0.55, 95% CI [0.38, 0.79]).

CONCLUSIONS: Timing of ED visits and consulting hematology are key factors influencing ED LOS in patients with hemophilia. These findings suggest areas for targeted improvements in ED management of patients with hemophilia.