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Delays in transfer of admitted patients boarded in the emergency department (ED) to an inpatient bed is a major driver of ED overcrowding. We sought to identify explanatory factors behind ED boarding as well as the impact of boarding on total inpatient length of stay (IP LOS) and inpatient mortality.
We conducted a retrospective single-centre observational study during the period between January 1 and December 31, 2015 at a very high volume community hospital. All patients admitted from the ED to Medicine, Pediatrics, Surgery, and Critical Care were identified. The mean ED LOS and boarding time as well as patient-specific and institutional factors that were independently associated with prolonged ED LOS (≥24 hours) and prolonged boarding time (≥12 hours) were identified. Mean inpatient length of stay (IP LOS) and the odds of inpatient mortality were calculated for those patients with prolonged ED wait times.
There were 13,872 unique admissions during the study period. Patients admitted to the Medicine service exhibited significantly higher ED wait times than other services. Within Medicine patients, there was a statistically significant greater odds of prolonged ED wait times for patients who were older, had a greater comorbidity burden, and required more specialized inpatient care. Medicine patients with prolonged boarding times also experienced a mean of 0.9 days longer IP LOS even after adjusting for confounders.
Within our cohort, older, sicker patients and those patients requiring more resource-intensive inpatient care had the longest ED wait times. These prolonged wait times are associated with significantly increased IP LOS.
Let X be either the d-dimensional sphere or a compact, simply connected, simple, connected Lie group. We define a mean-value operator analogous to the spherical mean-value operator acting on integrable functions on Euclidean space. The value of this operator will be written as ℳ f (x, a), where x ∈ X and a varies over a torus A in the group of isometries of X. For each of these cases there is an interval pO < p ≦ 2, where the p0 depends on the geometry of X, such that if f is in Lp (X) then there is a set full measure in X and if x lies in this set, the function a ↦ℳ f(x, a) has some Hölder continuity on compact subsets of the regular elements of A.
Let M be a compact Riemannian manifold equipped with Laplace–Beltrami operator Δ. We use the Rademacher-Menchoff theorem and the asymptotics of the eigenvalues of Δ to show that if a function belongs to an L2 Sobolev space of positive index then its expansion, in terms of eigenfunctions of Δ, converges almost everywhere on M.
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