Improving emergency department to hospital medicine transfer of care through electronic pass-off

A pilot admission leadership physician (ALP) program was experimented within a 693-bed, tertiary medical center with a 60-bed emergency department. This trial was intended to investigate whether having a physician triage potential patients would shorten patients' length-of-stay in the emergency department. After a emergency physician evaluated patients, ALP triaged them. The ALP ordered the appropriate bed for the patients if they qualified for the inpatient criteria, choosing among medical, medical telemetry, cardiac telemetry, intermediate care, or intensive care bed. The mean patient door-to-bed order time (time between patients reaching the emergency department to time to bed ordered by ALP) is 330.7 minutes (n = 234, SD = 151.68, 95% CI = 310.21–351.28) with ALP involvement. Compared with the mean door-to-bed order time of 337.8 minutes (n = 827, SD = 149.71, 95%CI = 326.98–348.57) without ALP, ALP shortened the waiting time by 7.09 minutes. During the same period, the door-to-physician time was 41.38 minutes (SD = 38.87 95%CI = 36.38–46.39), compared with 39.52 minutes (SD = 40.32, 95%CI = 36.77–42.27) before ALP. The time for patients waiting in the emergency department for other services such as surgery, psychiatry, and pediatrics also have decreased accordingly. Incorrect medical admissions such as scrambling to get the patient to the intensive care unit right after seeing patients has decreased (data not provided). Identifying physicians as physicians in the emergency department who triage potential admissions also has improved efficiencies within the hospital medicine group and bonding with ER physicians.

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Novel Transfer of Care Sign-out Assessment Tool in a Pediatric Emergency Department

Academic Pediatrics ◽

10.1016/j.acap.2017.08.009 ◽

2018 ◽

Vol 18 (1) ◽

pp. 86-93

Author(s):

Ara Festekjian ◽

Ameer P. Mody ◽

Todd P. Chang ◽

Nurit Ziv ◽

Alan L. Nager

Keyword(s):

Emergency Department ◽

Assessment Tool ◽

Pediatric Emergency ◽

Pediatric Emergency Department ◽

Transfer Of Care

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Transfer of care and offload delay: continued resistance or integrative thinking?

CJEM ◽

10.1017/cem.2014.62 ◽

2015 ◽

Vol 17 (6) ◽

pp. 679-684 ◽

Cited By ~ 6

Author(s):

Brian Schwartz

Keyword(s):

Emergency Department ◽

Prehospital Care ◽

Transfer Of Care ◽

Emergency Department Overcrowding ◽

The Past ◽

Innovative Solutions ◽

Integrative Process ◽

Thinking Process ◽

Trauma Teams ◽

Offload Delay

AbstractThe disciplines of paramedicine and emergency medicine have evolved synchronously over the past four decades, linked by emergency physicians with expertise in prehospital care. Ambulance offload delay (OD) is an inevitable consequence of emergency department overcrowding (EDOC) and compromises the care of the patient on the ambulance stretcher in the emergency department (ED), as well as paramedic emergency medical service response in the community. Efforts to define transfer of care from paramedics to ED staff with a view to reducing offload time have met with resistance from both sides with different agendas. These include the need to return paramedics to serve the community versus the lack of ED capacity to manage the patient. Innovative solutions to other system issues, such as rapid access to trauma teams, reducing door-to-needle time, and improving throughput in the ED to reduce EDOC, have been achieved by involving all stakeholders in an integrative thinking process. Only by addressing this issue in a similar integrative process will solutions to OD be realized.

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126: GOING UP! IMPROVING EMERGENCY DEPARTMENT TO INTENSIVE CARE NURSING AND PHYSICIAN TRANSFER OF CARE

Critical Care Medicine ◽

10.1097/01.ccm.0000618864.89994.e6 ◽

2020 ◽

Vol 48 (1) ◽

pp. 46-46

Author(s):

Anton Manasco ◽

Carrie Sona ◽

Christina Creel-Bulos ◽

Ethan Pfeifer ◽

Joanna Abraham ◽

...

Keyword(s):

Emergency Department ◽

Intensive Care ◽

Transfer Of Care ◽

Intensive Care Nursing ◽

Care Nursing

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Complex Transfer of Care of Surgical Patients in the Emergency Department: Ethical and Resource Utilization Issues

Clinical Pediatric Emergency Medicine ◽

10.1016/j.cpem.2014.08.004 ◽

2014 ◽

Vol 15 (3) ◽

pp. 274-277

Author(s):

Rowell Erin

Keyword(s):

Emergency Department ◽

Resource Utilization ◽

Surgical Patients ◽

Transfer Of Care

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Reduction of early inpatient transfers and rapid response team calls after implementation of an emergency department intake huddle process

BMJ Open Quality ◽

10.1136/bmjoq-2019-000862 ◽

2020 ◽

Vol 9 (1) ◽

pp. e000862

Author(s):

Sarah Hermanson ◽

Scott Osborn ◽

Christin Gordanier ◽

Evan Coates ◽

Barbara Williams ◽

...

Keyword(s):

Emergency Department ◽

Quality Improvement ◽

Elevated Serum ◽

Hospital Medicine ◽

Rapid Response Team ◽

Rapid Response ◽

Improvement Project ◽

Number Of Patients ◽

Response Team ◽

Gi Bleed

Patients admitted to the hospital and requiring a subsequent transfer to a higher level of care have increased morbidity, mortality and length of stay compared with patients who do not require a transfer during their hospital stay. We identified that a high number of patients admitted to our intermediate care (IMC) unit required a rapid response team (RRT) call and an early (<24 hours) transfer to the intensive care unit (ICU). A quality improvement project was initiated with the goal to reduce subsequent early transfers to the ICU and RRT calls. We started by focusing on IMC patients, implementing acuity-based nursing assignments and standardised daily nursing rounds in the IMC aiming to reduce early patient transfers to the ICU. Then, we expanded to all patients admitted to a hospital medical unit from the emergency department (ED), targeting patients with gastrointestinal (GI) bleed and sepsis who were at a higher risk for early transfer to the ICU. We then created an ED intake huddle process that over time was refined to target patients with SIRS criteria with an elevated serum lactic acid level greater than 2.0 mmol/L or a GI bleed with a haematocrit value less than 24%. These interventions resulted in an 10.8 percentage points (31.7% (225/710) to 20.9% (369/1764)) decrease in the early transfers to the ICU for all hospital medicine patients admitted to the hospital from the ED. Mean RRT calls/day decreased by 17%, from 3.0 mean calls/day preintervention to 2.5 mean calls/day postintervention. These quality improvement initiatives have sustained successful outcomes for over 6 years due to integrating enhanced team communication as organisational cultural norm that has become the standard.

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Impact on Length of Stay of a Hospital Medicine Emergency Department Boarder Service

Journal of Hospital Medicine ◽

10.12788/jhm.3337 ◽

2019 ◽

pp. 147-153

Author(s):

Kimiyoshi J Kobayashi ◽

Steven J Knuesel ◽

BBenjamin A White ◽

Marjory A Bravard ◽

Yuchiao Chang ◽

...

Keyword(s):

Emergency Department ◽

Length Of Stay ◽

Primary Outcome ◽

Medical Center ◽

Academic Medical Center ◽

Hospital Medicine ◽

General Medicine ◽

Cross Sectional Study ◽

Cross Sectional ◽

Median Hospital

BACKGROUND: It is not known whether delivering inpatient care earlier to patients boarding in the emergency department (ED) by a hospitalist-led team can decrease length of stay (LOS). OBJECTIVE: To study the association between care provided by a hospital medicine ED Boarder (EDB) service and LOS. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cross-sectional study (July 1, 2016 to June 30, 2018) conducted at a single, large, urban academic medical center. Patients admitted to general medicine services from the ED were included. EDB patients were defined as those waiting for more than two hours for an inpatient bed. Patients were categorized as covered EDB, noncovered EDB, or nonboarder. INTERVENTION: The hospital medicine team provided continuous care to covered EDB patients waiting for an inpatient bed. PRIMARY OUTCOME AND MEASURES: The primary outcome was median hospital LOS defined as the time period from ED arrival to hospital departure. Secondary outcomes included ED LOS and 30-day ED readmission rate. RESULTS: There were 8,776 covered EDB, 5,866 noncovered EDB, and 2,026 nonboarder patients. The EDB service covered 59.9% of eligible patients and 62.9% of total boarding hours. Median hospital LOS was 4.76 (interquartile range [IQR] 2.90-7.22) days for nonboarders, 4.92 (IQR 3.00-8.03) days for covered EDB patients, and 5.11 (IQR 3.16-8.34) days for noncovered EDB (P < .001). Median ED LOS for nonboarders was 5.6 (IQR 4.2-7.5) hours, 20.7 (IQR 15.8-24.9) hours for covered EDB, and 10.1 (IQR 7.9-13.8) hours for noncovered EDB (P < .001). There was no difference in 30-day ED readmission rates. CONCLUSION: Admitted patients who were not boarders had the shortest LOS. Among boarded patients, coverage by a hospital medicine-led EDB service was associated with a reduced hospital LOS.

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