Shift-changes for consultation services affect patient length-of-stay in the emergency department

Increased length-of-stay (LOS) within emergency departments (EDs) is a multifactorial issue that poses additional health risk to patients who chose to leave prior to seeing a physician and also places significant additional burden on ED physicians. Amongst many other patient-related and infrastructural factors, consultation service delay has been deemed a significant contributor to ED LOS across several international studies. We sought to further our understanding of infrastructural factors that contribute to consultation service delay and ED LOS by exploring the effect of shift-changes and patient handoffs. We conducted a retrospective descriptive study of patients receiving consultations in the UC Irvine Medical Center Emergency Department to assess differences in Consultation Duration during timeperiods encompassing a shift change for the consultation service. The two 3-hour intervals with the lowest proportion of acceptable consultation durations (set as 120 minutes) encompassed shift changes and it was not attributable to high workload. Our results serve as preliminary evidence for the need for improved staffing during shift-changes or new shift-change policies to support consultation services during these times. This data also suggests that predictive models built to support operational and administrative decision making in the ED should incorporate shift-change periods and staffing during these times.