Our findings may also inform public and private policymakers on a broad range of issues including, but not limited to, Monday volume, impact of hospital bed size and hospital status on the mean duration of T&R ED visits, and differences in duration by race. Some of the results are consistent with the literature’s characterization of care provided in the ED and are expected. Level I trauma centers, for example, have comprehensive AP24534 mw resources and are able to care for the most severely injured patients. They also provide leadership in education and research.

Therefore, it is not surprising that they have the longest duration for T&R patients. Other findings are not as easy to interpret. We found earlier that a larger share Inhibitors,research,lifescience,medical of patients transferred to short-term hospitals or other facilities could be one of the contributing factors for longer duration of visits at non-trauma hospitals when compared to Level 2 or Level 3 trauma centers. However, it is still Inhibitors,research,lifescience,medical not clear why non-trauma hospitals should have a longer duration than Level 2 or Level 3 trauma centers. Many of these findings are worthy of further exploration. For example, we believe that since elderly patients frequently present to the ED with multiple complications, they require more ED resources during their visits, which causes them

to have a longer duration of visit. Similarly, one plausible explanation for midnight spike in duration Inhibitors,research,lifescience,medical on Mondays might be that healthcare personnel change shifts at this time and/or a reduction in other resources between 11 p.m. and midnight. Another plausible explanation might be that healthcare personnel might experience decrease in their labor productivity towards ends of their shifts. Some researchers may claim that our Inhibitors,research,lifescience,medical multilevel model estimates produced higher intra-class correlations since the higher the intra-class correlation, the less unique the information provided by each additional patient.

Nonetheless, our goal is to show the source of Inhibitors,research,lifescience,medical variation between hospitals and patients. Further research using more clustering with fewer cases per cluster is warranted. We also believe that our findings may provide unique opportunities for quality improvements within hospital emergency departments, as we presented sizable variation in duration of T&R ED visits across a wide range of patient and hospital characteristics. Endnotes aFurther details about these data files are available else at http://www.cdc.gov/nchs/ahcd.htm bFurther details about HCUP databases are available at http://www.hcup-us.ahrq.gov/ cFurther details are available at http://www.hcup-us.ahrq.gov/tech_assist/centdist.jsp dAs part of the HCUP Project, AHRQ negotiates with data organizations that maintain statewide data systems to acquire hospital-based data, process those data into research databases, and subsequently release a subset of those data to the public with a signed data use agreement.