Impact of Rapid Medical Evaluation on Patient Flow in an Urban Emergency Department

Purpose: Assess the impact of 24/7/365 emergency trauma radiology (ETR) coverage on Emergency Department (ED) patient flow in an urban, quaternary-care teaching hospital. Methods: Patient ED visit and imaging information were extracted from the hospital patient care information system for 2008 to 2018. An interrupted time-series approach with a comparison group was used to study the impact of 24/7/365 ETR on average monthly ED length of stay (ED-LOS) and Emergency Physician to disposition time (EP-DISP). Linear regression models were fit with abrupt and permanent interrupts for 24/7/365 ETR, a coefficient for comparison series and a SARIMA error term; subgroup analyses were performed by patient arrival time, imaging type and chief complaint. Results: During the study period, there were 949,029 ED visits and 739,796 diagnostic tests. Following implementation of 24/7/365 coverage, we found a significant decrease in EP-DISP time for patients requiring only radiographs (-29 min;95%CI:-52,-6) and a significant increase in EP-DISP time for major trauma patients (46 min;95%CI:13,79). No significant change in patient throughput was observed during evening hours for any patient subgroup. For overnight patients, there was a reduction in EP-DISP for patients with symptoms consistent with stroke (-78 min;95%CI:-131,-24) and for high acuity patients who required imaging (-33 min;95%CI:-57,-10). Changes in ED-LOS followed a similar pattern. Conclusions: At our institution, 24/7/365 in-house ETR staff radiology coverage was associated with improved ED flow for patients requiring only radiographs and for overnight stroke and high acuity patients. Major trauma patients spent more time in the ED, perhaps reflecting the required multidisciplinary management.

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688 Rapid Implementation of Virtual Fracture Clinic During COVID 19 Reduces Both Face-To-Face Appointments and Facilitates Rapid Feedback and Education to Be Delivered to The Emergency Department

British Journal of Surgery ◽

10.1093/bjs/znab135.027 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

T Havenhand ◽

L Hoggett ◽

A Bhutta

Keyword(s):

Emergency Department ◽

Patient Flow ◽

Prospective Data ◽

Fracture Clinic ◽

Face To Face ◽

Return Rates ◽

Acute Hospitals ◽

Virtual Fracture Clinic ◽

Improve Patient

Abstract Introduction COVID-19 has dictated a shift towards virtual clinics. Pennine Acute Hospitals NHS Trust serves over a million patients with a significant number of face-to-face fracture clinics. Introduction of a Virtual Fracture Clinic (VFC) reduces hospital return rates and improves patient experience. The referral data can be used to give immediate monthly feedback to the referring department to further improving patient flow. Method Prospective data was collected for all referrals to VFC during March 2020. Data included referral diagnosis, actual diagnosis, referrers grade, and final outcome. Results 630 referrals were made to VFC. 347 (55%) of those referrals were directly discharged without the need for physical consultation. Of these 114 (32%) were injuries which can be discharged by the Emergency Department with an advice leaflet using existing pathways. Of the remaining discharges 102 (29%) were query fractures or sprains; and 135 (39%) were minor fractures; which needed only advice via a letter and no face to face follow up. Conclusions Implementation of VFC leads to a decrease in physical appointments by 55% saving 347 face to face appointments. The new system has also facilitated effective audit of referrals in order to further improve patient flow from the Emergency Department via feedback mechanisms and education.

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428 Prevalence of Homelessness and Housing Insecurity in an Urban Emergency Department

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2017.07.307 ◽

2017 ◽

Vol 70 (4) ◽

pp. S167 ◽

Cited By ~ 1

Author(s):

T.S. Jackson ◽

T. Moran ◽

J. Lin ◽

B.A. Salhi

Keyword(s):

Emergency Department ◽

Urban Emergency Department

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Improving patient flow in emergency department through dynamic priority queue

2012 IEEE International Conference on Automation Science and Engineering (CASE) ◽

10.1109/coase.2012.6386409 ◽

2012 ◽

Cited By ~ 6

Author(s):

Kar Way Tan ◽

Chao Wang ◽

Hoong Chuin Lau

Keyword(s):

Emergency Department ◽

Patient Flow ◽

Priority Queue ◽

Dynamic Priority

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Simulation of a Hospital Disaster Plan: A Virtual, Live Exercise

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00005999 ◽

2008 ◽

Vol 23 (4) ◽

pp. 346-353 ◽

Cited By ~ 16

Author(s):

Jeffrey M. Franc-Law ◽

Michael Bullard ◽

F. Della Corte

Keyword(s):

Emergency Department ◽

Patient Flow ◽

Learning Experience ◽

Significant Degree ◽

Primary Objective ◽

Simulated Patients ◽

Disaster Plan ◽

Actual Patient ◽

Patient Database ◽

Rate Limiting

AbstractIntroduction:Currently, there is no widely available method to evaluate an emergency department disaster plan. Creation of a standardized patient data- base and the use of a virtual, live exercise may lead to a standardized and reproducible method that can be used to evaluate a disaster plan.Purpose:A virtual, live exercise was designed with the primary objective of evaluating a hospital's emergency department disaster plan. Education and training of participants was a secondary goal.Methods:A database (disastermed.ca) of histories, physical examination findings, and laboratory results for 136 simulated patients was created using information derived from actual patient encounters.The patient database was used to perform a virtual, live exercise using a training version of the emergency department's information system software.Results:Several solutions to increase patient flow were demonstrated during the exercise. Conducting the exercise helped identify several faults in the hospital disaster plan, including outlining the important rate-limiting step. In addition, a significant degree of under-triage was demonstrated. Estimates of multiple markers of patient flow were identified and compared to Canadian guidelines. Most participants reported that the exercise was a valuable learning experience.Conclusions:A virtual, live exercise using the disastermed.ca patient database was an inexpensive method to evaluate the emergency department disaster plan. This included discovery of new approaches to managing patients, delineating the rate-limiting steps, and evaluating triage accuracy. Use of the patient timestamps has potential as a standardized international benchmark of hospital disaster plan efficacy. Participant satisfaction was high.

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