The Effect of Emergency Department Expansion on Emergency Department Patient Flow

Introduction:Overcrowding in the emergency department (ED) has been a global problem for a long time, but it is still not resolved.Aim:To determine if an ED expansion would be effective in resolving overcrowding.Methods:This was a retrospective study comparing two 10-month periods before (September 2015 to June 2016) and after (September 2017 to June 2018) the ED expansion in an urban tertiary hospital. The existing ED consisted of 45 beds in the adult area and eight beds in the pediatric area. After the construction, the number of beds was not increased, but a fast track area was newly established in the adult area, and a 25-bed ward for emergency hospitalized patients was opened.Results:The number of patients visiting the ED increased from 77,078 to 87,927. The proportion of patients who returned home without treatment significantly decreased from 11.5% to 0.9% (p<0.001). The number of adult patients increased from 40,814 to 60,720, but the number of patients who could be treated on the bed decreased (22,166 (54.3%) vs. 17,776 (29.3%), p<0.001). The number of pediatric patients was similar in both periods. Median ED length of stay (LOS) of total patients increased from 193.0 min to 205.8 min (p<0.001). Of the 18,900 hospitalized patients during post-period, 1,255 (6.64%) were admitted to the emergency ward, and the boarding (from admission decision to hospitalization) time of the admitted patients decreased from 239.2 min in the pre-period to 190.9 min in the post-period by 38.3 min. However, more time was required for admission decision in the post-period (216.8 vs. 253.3, p<0.001).Discussion:The ED expansion allowed more patients to be treated, and the emergency ward reduced boarding times of admitted patients. However, due to the increase in the number of patients, the time required for medical treatment increased.

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Accuracy of Computer Simulation to Predict Patient Flow during Mass-Casualty Incidents

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00006002 ◽

2008 ◽

Vol 23 (4) ◽

pp. 354-360 ◽

Cited By ~ 5

Author(s):

Jeffrey M. Franc-Law ◽

Micheal J. Bullard ◽

F. Della Corte

Keyword(s):

Emergency Department ◽

Computer Simulation ◽

Patient Care ◽

Patient Flow ◽

Emergency Department Patient ◽

Simulation Software ◽

Simulated Patients ◽

Disaster Plan ◽

Data Set ◽

Patient Database

AbstractIntroduction:Although most hospitals have an emergency department disas- ter plan, most never have been implemented in a true disaster or been tested objectively. Computer simulation may be a useful tool to predict emergency department patient flow during a disaster.Purpose:The aim of this study was to compare the accuracy of a computer simulation in predicting emergency department patient flow during a masscasualty incident with that of a real-time, virtual, live exercise.Methods:History, physical examination findings, and laboratory results for 136 simulated patients were extracted from the disastermed.ca patient database as used as input into a computer simulation designed to represent the emergency department at the University of Alberta Hospital.The computer simulation was developed using a commercially available simulation software platform (2005, SimProcess, CACI Products, San Diego CA). Patient flow parameters were compared to a previous virtual, live exercise using the same data set.Results:Although results between the computer simulation and the live exercise appear similar, they differ statistically with respect to many patient benchmarks. There was a marked difference between the triage codes assigned during the live exercise and those from the patient database; however, this alone did not account for the differences between the patient groups. It is likely that novel approaches to patient care developed by the live exercise group, which are difficult to model by computer software, contributed to differences between the groups. Computer simulation was useful, however, in predicting how small changes to emergency department structure, such as adding staff or patient care areas, can influence patient flow.Conclusions:Computer simulation is helpful in defining the effects of changes to a hospital disaster plan. However, it cannot fully replace participant exercises. Rather, computer simulation and live exercises are complementary, and both may be useful for disaster plan evaluation.

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The impact of medical specialist staffing on emergency department patient flow and satisfaction

European Journal of Emergency Medicine ◽

10.1097/mej.0000000000000487 ◽

2019 ◽

Vol 26 (1) ◽

pp. 47-52 ◽

Cited By ~ 5

Author(s):

M. Christien van der Linden ◽

Roeline A.Y. de Beaufort ◽

Sven A.G. Meylaerts ◽

Crispijn L. van den Brand ◽

Naomi van der Linden

Keyword(s):

Emergency Department ◽

Patient Flow ◽

Emergency Department Patient ◽

Medical Specialist ◽

The Impact

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Emergency Department Patient Flow: The Influence of Hospital Census Variables on Emergency Department Length of Stay

Academic Emergency Medicine ◽

10.1111/j.1553-2712.2009.00397.x ◽

2009 ◽

Vol 16 (7) ◽

pp. 597-602 ◽

Cited By ~ 65

Author(s):

Ray Lucas ◽

Heather Farley ◽

Joseph Twanmoh ◽

Andrej Urumov ◽

Nils Olsen ◽

...

Keyword(s):

Emergency Department ◽

Length Of Stay ◽

Patient Flow ◽

Emergency Department Patient

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Tracking the patient journey by combining multiple hospital database systems

Australian Health Review ◽

10.1071/ah13070 ◽

2014 ◽

Vol 38 (3) ◽

pp. 332 ◽

Cited By ~ 5

Author(s):

Andy Wong ◽

Erhan Kozan ◽

Michael Sinnott ◽

Lyndall Spencer ◽

Robert Eley

Keyword(s):

Emergency Department ◽

Information System ◽

Information Systems ◽

Patient Flow ◽

Database Systems ◽

Tertiary Hospital ◽

Patient Data ◽

Public Hospitals ◽

Patient Journey ◽

Corporate Information System

With new national targets for patient flow in public hospitals designed to increase efficiencies in patient care and resource use, better knowledge of events affecting length of stay will support improved bed management and scheduling of procedures. This paper presents a case study involving the integration of material from each of three databases in operation at one tertiary hospital and demonstrates it is possible to follow patient journeys from admission to discharge. What is known about this topic? At present, patient data at one Queensland tertiary hospital are assembled in three information systems: (1) the Hospital Based Corporate Information System (HBCIS), which tracks patients from in-patient admission to discharge; (2) the Emergency Department Information System (EDIS) containing patient data from presentation to departure from the emergency department; and (3) Operation Room Management Information System (ORMIS), which records surgical operations. What does this paper add? This paper describes how a new enquiry tool may be used to link the three hospital information systems for studying the hospital journey through different wards and/or operating theatres for both individual and groups of patients. What are the implications for practitioners? An understanding of the patients’ journeys provides better insight into patient flow and provides the tool for research relating to access block, as well as optimising the use of physical and human resources.

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Specialized fast track: a sustainable model to improve emergency department patient flow

Journal of Hospital Administration ◽

10.5430/jha.v4n5p40 ◽

2015 ◽

Vol 4 (5) ◽

pp. 40

Author(s):

Emilpaolo Manno ◽

Marco Pesce ◽

Umberto Stralla ◽

Federico Festa ◽

Silvio Geninatti ◽

...

Keyword(s):

Emergency Department ◽

Length Of Stay ◽

Fast Track ◽

Patient Flow ◽

Wait Time ◽

Emergency Department Patient ◽

Care Needs ◽

Time Length ◽

Hospital Units ◽

Ed Visits

Objective: Emergency department (ED) overcrowding is a hospital-wide problem that demands a whole-hospital solution. We developed and implemented a fast track model for streaming ED patients with low-acuity illness or injury to specialized care areas (gynecology-obstetrics, orthopedics-trauma, pediatrics, and primary care) staffed by existing specialist resources with access to general ED services. The study aim was to determine whether streaming of ED visits into specialized fast track areas increased operational efficiency and improved patient flow in a mixed adult and pediatric ED without incurring extra costs.Methods: We retrospectively reviewed the ED discharge records of patients who were mainstreamed or fast tracked during the 3-year period from 1 January 2010 through 31 December 2012. ED visits were identified according to a five-level triage scheme; performance indicators were compared for: wait time, length of stay, leave before being seen and revisit rates.Results: A reduction in wait time, length of stay, and leave before being seen rate was seen with fast track streaming (p < .01). These improvements were achieved without additional medical and nurse staffing.Conclusions: Specialized fast track streaming helped us meet patients’ care needs and contain costs. Lower-acuity patients were seen quickly by a specialist and safely discharged or admitted to the hospital without diverting resources from patients with high-acuity illness or injury. Involvement of all stakeholders in seeking a sustainable solution to ED crowding as a hospital-wide problem was key to enhancing cooperation between the ED and the hospital units.

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147: Improving Emergency Department Patient Flow Through Optimal Fast Track Usage

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2008.06.061 ◽

2008 ◽

Vol 52 (4) ◽

pp. S88 ◽

Cited By ~ 6

Author(s):

J. Peck ◽

S. Kim

Keyword(s):

Emergency Department ◽

Fast Track ◽

Patient Flow ◽

Emergency Department Patient ◽

Flow Through

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The Impact of Triage Classification and Level of Training on Emergency Department Patient Flow As Measured by Use of a Web-Based Infrared Passive-Tracking System

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2005.06.380 ◽

2005 ◽

Vol 46 (3) ◽

pp. 103

Author(s):

L.A. Villarin ◽

J. Fisher ◽

S. Rapone ◽

C. Chudnofsky

Keyword(s):

Emergency Department ◽

Patient Flow ◽

Tracking System ◽

Emergency Department Patient ◽

Web Based ◽

Passive Tracking ◽

Level Of Training ◽

The Impact ◽

Triage Classification

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THE EFFECT OF A BOARDING RESTRICTION PROTOCOL ON EMERGENCY DEPARTMENT CROWDING

10.1101/2021.05.01.21255822 ◽

2021 ◽

Author(s):

Ji Hwan Lee ◽

Ji Hoon Kim ◽

Incheol Park ◽

Hyun Sim Lee ◽

Joon Min Park ◽

...

Keyword(s):

Emergency Department ◽

Length Of Stay ◽

Primary Outcome ◽

Treatment Time ◽

Patient Flow ◽

Hospital Beds ◽

Before And After ◽

Day Of The Week ◽

Ed Crowding ◽

Post Period

ABSTRACT Background Access block due to a lack of hospital beds causes emergency department (ED) crowding. We initiated the boarding restriction protocol that limits ED length of stay (LOS) for patients awaiting hospitalization to 24 hours from arrival. This study aimed to determine the effect of the protocol on ED crowding. Method This was a pre-post comparative study to compare ED crowding before and after protocol implementation. The primary outcome was the red stage fraction with more than 71 occupying patients in the ED (severe crowding level). LOS in the ED, treatment time and boarding time were compared. Additionally, the pattern of boarding patients staying in the ED according to the day of the week was confirmed. Results Analysis of the number of occupying patients in the ED, measured at 10-minute intervals, indicated a decrease from 65.0 (51.0-79.0) to 55.0 (43.0-65.0) in the pre- and post-periods, respectively (p<0.0001). The red stage fraction decreased from 38.9% to 15.1% of the pre- and post-periods, respectively (p<0.0001). The proportion beyond the goal of this protocol of 24 hours decreased from 7.6% to 4.0% (p<0.0001). The ED LOS of all patients was similar: 238.2 (134.0-465.2) and 238.3 (136.9-451.2) minutes in the pre- and post-periods, respectively. In admitted patients, ED LOS decreased from 770.7 (421.4-1587.1) to 630.2 (398.0-1156.8) minutes (p<0.0001); treatment time increased from 319.6 (198.5-482.8) to 344.7 (213.4-519.5) minutes (p<0.0001); and boarding time decreased from 298.9 (109.5-1149.0) to 204.1 (98.7-545.7) minutes (p<0.0001). In the pre-period, boarding patients accumulated in the ED on weekdays, with the accumulation resolved on Fridays; this pattern was alleviated in the post-period. Conclusions The protocol effectively resolved excessive ED crowding by alleviating the accumulation of boarding patients in the ED on weekdays. Additional studies should be conducted on changes this protocol brings to patient flow hospital-wide.

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The effects of the coronavirus disease 2019 pandemic on neurospine surgery practice in the referral center hospital developing country

Surgical Neurology International ◽

10.25259/sni_708_2021 ◽

2021 ◽

Vol 12 ◽

pp. 620

Author(s):

Galih Indra Permana ◽

Muhammad Faris ◽

Eko Agus Subagio ◽

Abdul Hafid Bajamal

Keyword(s):

Emergency Department ◽

Surgical Procedure ◽

Outpatient Visit ◽

Emergency Department Patient ◽

Tertiary Hospital ◽

Surgical Practice ◽

Outpatient Visits ◽

Center Hospital ◽

Recorded Data ◽

And Training

Background: The coronavirus disease 2019 (COVID-19) pandemic represents a once in a century challenge to human health care with over 4.5 million cases and over 300,000 deaths thus far. Surgical practice has been significantly impacted with all specialties writing guidelines for how to manage during this crisis. This study reported the effect of the COVID-19 pandemic on the neurosurgical practice, especially neurospine, in the outpatient visit, emergency department, and the surgical procedure. Methods: This study is the comparative retrospective about neurospine practice in the outpatient visit, emergency department, and the surgical procedure among before and during COVID-19 pandemic. We recorded data from January to December 2019 (before COVID-19 pandemic) and compared with the same period in the 2020 (during a COVID-19 pandemic). Results: A total of the outpatient visits, the average number per month was 28 ± 10.5 visits per month before the pandemic. The average number outpatient visit per month during the pandemic was 19 ± 11.1 visits per month, with the lowest in July 2020. The result of the average monthly neurospine surgical procedure before the pandemic was 5 ± 1.9 operations per month. Compared during the pandemic, there was decreased in the neurospine surgical procedure with the average number was 2 ± 2.7 operations per month. The decreased number significantly happens in the surgical procedure and emergency department patient (P < 0.05), while in the outpatient visit, the decreased statistically not significantly (P > 0.05). Conclusion: The COVID-19 pandemic changed all scopes of medical practice and training. Considering the limitation in the available resources, the number of educational cases may decrease in subspecialized disciplines such as neurospine neurosurgery. The COVID-19 pandemic affects in the neurospine and neurosurgery treatment policy in the referral tertiary hospital.

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