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Objectives  The objective was to examine the relationship between laboratory testing (including test volume and turnaround time [ TAT ]) and emergency department ( ED ) length of stay ( LOS ), using linked patient‐level data from four hospitals across 4 years.    Methods  This was a retrospective, multisite cohort study of patients presenting to any one of four  ED s in New South Wales, Australia, during a 2‐month period (August and September) in 2008, 2009, 2010, and 2011. Data from  ED  information systems were linked to laboratory test data. A cross‐classified random‐effect modeling approach was applied to identify factors affecting  ED LOS , taking into account the correlation between patients' presentations at the same hospital and/or in the same calendar year. Number of test order episodes (tests ordered at one point in time during the  ED  stay) and  TAT  (time from laboratory order receipt to result available) were examined.    Results  As the number of test order episodes increased, so did the duration of patient  ED LOS  (p  <  0.0001). For every five additional tests ordered per test order episode, the median  ED LOS  increased by 10 minutes (2.9%, p  <  0.0001); each 30‐minute increase in  TAT  was, on average, associated with a 5.1% (17 minutes; p  <  0.0001) increase in  ED LOS , after adjustment for other factors. Patients presenting to the  ED  at night (7 p.m. to 7 a.m.) had longer stays than those presenting during the daytime, although the median  TAT s at nights were shorter than those during the daytime.    Conclusions  Laboratory testing has a direct effect on patients'  LOS  in  ED . Laboratory  TAT , number of testing episodes, and test volume influence  ED LOS . Targeted increases of  ED  resources and staffing after‐hours may also contribute to reductions in  ED LOS .

academic emergency medicine

The Effect of Laboratory Testing on Emergency Department Length of Stay: A Multihospital Longitudinal Study Applying a Cross‐classified Random‐effect Modeling Approach