National Emergency Access Targets metrics of the emergency department–inpatient interface: measures of patient flow and mortality for emergency admissions to hospital

2015 ◽  
Vol 39 (5) ◽  
pp. 533 ◽  
Author(s):  
Clair Sullivan ◽  
Andrew Staib ◽  
Rob Eley ◽  
Alan Scanlon ◽  
Judy Flores ◽  
...  
Keyword(s):  
Emergency Department ◽  
Patient Flow ◽  
Time Interval ◽  
Inverse Relation ◽  
Bed Occupancy ◽  
Emergency Admissions ◽  
Emergency Patients ◽  
Number Of Patients ◽  
Hospital Bed ◽  
National Emergency

Background Movement of emergency patients across the emergency department (ED)–inpatient ward interface influences compliance with National Emergency Access Targets (NEAT). Uncertainty exists as to how best measure patient flow, NEAT compliance and patient mortality across this interface. Objective To compare the association of NEAT with new and traditional markers of patient flow across the ED–inpatient interface and to investigate new markers of mortality and NEAT compliance across this interface. Methods Retrospective study of consecutive emergency admissions to a tertiary hospital (January 2012 to June 2014) using routinely collected hospital data. The practical access number for emergency (PANE) and inpatient cubicles in emergency (ICE) are new measures reflecting boarding of inpatients in ED; traditional markers were hospital bed occupancy and ED attendance numbers. The Hospital Standardised Mortality Ratio (HSMR) for patients admitted via ED (eHSMR) was correlated with inpatient NEAT compliance rates. Linear regression analyses assessed for statistically significant associations (expressed as Pearson R coefficient) between all measures and inpatient NEAT compliance rates. Results PANE and ICE were inversely related to inpatient NEAT compliance rates (r = 0.698 and 0.734 respectively, P < 0.003 for both); no significant relation was seen with traditional patient flow markers. Inpatient NEAT compliance rates were inversely related to both eHSMR (r = 0.914, P = 0.0006) and all-patient HSMR (r = 0.943, P = 0.0001). Conclusions Traditional markers of patient flow do not correlate with inpatient NEAT compliance in contrast to two new markers of inpatient boarding in ED (PANE and ICE). Standardised mortality rates for both emergency and all patients show a strong inverse relation with inpatient NEAT compliance. What is known about the topic? Impaired flow of emergency admissions across the interface between ED and inpatient wards retards achievement of NEAT-compliance rates and adversely affects patient outcomes. Uncertainty exists as to which measures of patient flow and mortality outcomes correlate closely with NEAT-compliance rates for patients admitted from emergency departments. What does this paper add? This study investigates the utility of two new markers of patient flow from ED to inpatient wards. The Practical Access Number for Emergency (PANE) is the number of patients in ED who have had their episode of ED care completed and are awaiting an inpatient bed at a particular point in time. The Inpatient Cubicles in Emergency (ICE) represents the theoretical number of ED cubicles blocked by boarding patients over a specified time interval (in this study 5 weekdays, Monday–Friday), based on the mean time boarders spent in ED during that interval. Both measures were shown to be significantly inversely related to inpatient NEAT compliance rates (i.e. as PANE and ICE increased, NEAT compliance decreased). In contrast, no relation was seen with traditional markers of patient flow (i.e. hospital bed occupancy and ED attendance numbers). HSMR for both all patients and emergency patients only demonstrated a strong inverse relation with inpatient NEAT compliance. What are the implications for practitioners? When pursuing higher NEAT compliance rates, traditional markers of patient flow across the ED–inpatient interface may be misleading and adversely impact bed-management strategies and patient safety. Identifying when hospitals may be at risk of developing, or already in, a state of reduced access to emergency care may be performed more accurately using new flow markers such as PANE and ICE. The inverse relationship between inpatient NEAT compliance and HSMR, whether calculated for all patients or for emergency patients only, underscores the dependence of inpatient mortality on the swift flow of large volumes of emergency admissions across the ED–inpatient interface. This flow may be compromised by imposing additional demands on a limited number of commissionable beds by way of increasing ED demand and/or use of more beds for elective admissions.

scholarly journals Patients with acute stroke are less likely to be admitted directly to a stroke unit when hospital beds are scarce: A Swedish multicenter register study

2017 ◽  
Vol 2 (2) ◽  
pp. 178-186 ◽  
Author(s):  
David Darehed ◽  
Bo Norrving ◽  
Birgitta Stegmayr ◽  
Karin Zingmark ◽  
Mathias C. Blom
Keyword(s):  
Emergency Department ◽  
Confidence Interval ◽  
Acute Stroke ◽  
Odds Ratio ◽  
Stroke Unit ◽  
Register Study ◽  
Bed Occupancy ◽  
Hospital Beds ◽  
Hospital Bed ◽  
Direct Admission

Introduction It is well established that managing patients with acute stroke in dedicated stroke units is associated with improved functioning and survival. The objectives of this study are to investigate whether patients with acute stroke are less likely to be directly admitted to a stroke unit from the Emergency Department when hospital beds are scarce and to measure variation across hospitals in terms of this outcome. Patients and methods This register study comprised data on patients with acute stroke admitted to 14 out of 72 Swedish hospitals in 2011–2014. Data from the Swedish stroke register were linked to administrative daily data on hospital bed occupancy (measured at 6 a.m.). Logistic regression analysis was used to analyse the association between bed occupancy and direct stroke unit admission. Results A total of 13,955 hospital admissions were included; 79.6% were directly admitted to a stroke unit from the Emergency Department. Each percentage increase in hospital bed occupancy was associated with a 1.5% decrease in odds of direct admission to a stroke unit (odds ratio = 0.985, 95% confidence interval = 0.978–0.992). The best-performing hospital exhibited an odds ratio of 3.8 (95% confidence interval = 2.6–5.5) for direct admission to a stroke unit versus the reference hospital. Discussion and conclusion We found an association between hospital crowding and reduced quality of care in acute stroke, portrayed by a lower likelihood of patients being directly admitted to a stroke unit from the Emergency Department. The magnitude of the effect varied considerably across hospitals.

The Effect of Hospital Bed Occupancy on Throughput in the Pediatric Emergency Department

2009 ◽  
Vol 53 (6) ◽  
pp. 767-776.e3 ◽  
Author(s):  
Debra F. Hillier ◽  
Gareth J. Parry ◽  
Michael W. Shannon ◽  
Anne M. Stack
Keyword(s):  
Emergency Department ◽  
Pediatric Emergency ◽  
Pediatric Emergency Department ◽  
Bed Occupancy ◽  
Hospital Bed

Forecasting emergency department admissions

2021 ◽  
Vol 25 (6) ◽  
pp. 1579-1601
Author(s):  
Carlos Narciso Rocha ◽  
Fátima Rodrigues
Keyword(s):  
Neural Network ◽  
Emergency Department ◽  
Recurrent Neural Network ◽  
Patient Flow ◽  
Clinical Staff ◽  
Quality Service ◽  
Emergency Admissions ◽  
Machine Learning Methods ◽  
Recurrent Neuronal Network ◽  
High Quality Service

The emergency department of a hospital plays an extremely important role in the healthcare of patients. To maintain a high quality service, clinical professionals need information on how patient flow will evolve in the immediate future. With accurate emergency department forecasts it is possible to better manage available human resources by allocating clinical staff before peak periods, thus preventing service congestion, or releasing clinical staff at less busy times. This paper describes a solution developed for the presentation of hourly, four-hour, eight-hour and daily number of admissions to a hospital’s emergency department. A 10-year history (2009–2018) of the number of emergency admissions in a Portuguese hospital was used. To create the models several methods were tested, including exponential smoothing, SARIMA, autoregressive and recurrent neural network, XGBoost and ensemble learning. The models that generated the most accurate hourly time predictions were the recurrent neural network with one-layer (sMAPE = 23.26%) and with three layers (sMAPE = 23.12%) and XGBoost (sMAPE = 23.70%). In terms of efficiency, the XGBoost method has by far outperformed all others. The success of the recurrent neuronal network and XGBoost machine learning methods applied to the prediction of the number of emergency department admissions has been demonstrated here, with an accuracy that surpasses the models found in the literature.

scholarly journals The Effect of Emergency Department Expansion on Emergency Department Patient Flow

2019 ◽  
Vol 34 (s1) ◽  
pp. s123-s124
Author(s):  
Min Joung Kim ◽  
Joon Min Park
Keyword(s):  
Emergency Department ◽  
Patient Flow ◽  
Emergency Department Patient ◽  
Tertiary Hospital ◽  
Hospitalized Patients ◽  
Emergency Ward ◽  
Admission Decision ◽  
Number Of Patients ◽  
Time Required ◽  
Post Period

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.

Hospital Bed Occupancy due to Drug-Related Problems1

1980 ◽  
Vol 73 (12) ◽  
pp. 853-856 ◽  
Author(s):  
Karabi Ghose
Keyword(s):  
Hospital Admissions ◽  
District General Hospital ◽  
Drug Related Problems ◽  
Bed Occupancy ◽  
Number Of Patients ◽  
Common Causes ◽  
Hospital Bed ◽  
Bronchopulmonary Diseases ◽  
Duration Of Hospitalization ◽  
The Mean

The number of patients admitted for drug-related problems and the duration of inpatient treatment required primarily for drug reactions and/or related problems during the period 1 October to 31 December 1979 were studied in one of the three general medical units of a district general hospital. 93% of all patients were admitted as emergencies either through the casualty department or at the their own general practitioner's request. Acute self-poisoning (9.9%) and other drug-related problems (8.8%) were, respectively, the third and fifth most common causes of hospital admission. These two conditions jointly (all drug-related problems) appeared to be the second most common cause and accounted for 18.7% of hospital admissions. The mean duration of hospitalization in patients with drug-related problems, excluding self-poisoning, was approximately 8 days. This was almost identical to hospital bed occupancy due to bronchopulmonary diseases (8.3 days) and complications of diabetes mellitus (8.4 days).

scholarly journals P124: The Ottawa Chest Pain Rule would increase stretcher capacity if implemented for cardiac chest pain patients

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S119-S119 ◽  
Author(s):  
M. Sonntag ◽  
E. Lang
Keyword(s):  
Emergency Department ◽  
Chest Pain ◽  
Patient Flow ◽  
System Capacity ◽  
Cardiac Monitoring ◽  
Convenience Sample ◽  
Heart Score ◽  
Number Of Patients ◽  
The Impact ◽  
Pain Patients

Introduction: Reducing the number of patients requiring cardiac monitoring would increase system capacity and improve emergency department (ED) patient flow. The Ottawa Chest Pain Rule helps physicians identify chest pain patients who do not require cardiac monitoring and is based on a ‘normal or non-specific’ ECG and being pain-free on initial physician assessment. Our objective was to measure the impact that the implementation of this decision rule would have on cardiac monitoring bed utilization in adult EDs in Calgary. Methods: A convenience sample of patients was prospectively obtained at each of the four Calgary adult emergency sites. All patients presenting with the Canadian Triage Acuity Scale chief complaint of “cardiac pain”, or “chest pain with cardiac features” were captured for inclusion in the study. Real time interviews and survey assessments were conducted with the primary nurse and physician involved in each patient’s care. Results: A total of 61 patients were captured by the study. Physicians identified cardiac as the primary rule-out pathology in 51% of these patients. The average Heart Score of all study patients was 4.2, and 30% of patients were ultimately admitted. Physicians believed that 39% of the 61 patients needed cardiac monitoring, while primary nurses believed that 59% needed monitoring. Of the 61 patients, 59% were triaged to areas providing cardiac monitoring. The application of the Ottawa Rule would have allowed 47% of patients triaged to cardiac monitoring to be taken off cardiac monitoring. This would translate to a total of greater than 74 hours saved or a reduction of 30% of the total cardiac monitored patient time. Conclusion: The Ottawa rule appears to be a low-risk emergency department flow intervention that has the potential to help reduce resource utilization in emergency departments. This change may result in increased emergency department capacity and improved overall patient flow. This simple rule based only on ECG findings and absence of chest pain can easily be applied and implemented without increasing physician workload or increasing risk to patients.

Assessment of Daily Burden and Factors for Overcrowded Emergency Department at Tertiary Care Hospital of Karachi

2021 ◽  
pp. 30-35
Author(s):  
Arsala Faridi ◽  
Farah Ahmad ◽  
Areej Zehra ◽  
Afreen Fazal
Keyword(s):  
Emergency Department ◽  
Emergency Room ◽  
Tertiary Care Hospital ◽  
Patient Flow ◽  
Tertiary Care ◽  
Care Hospital ◽  
Cross Sectional ◽  
Study Duration ◽  
Number Of Patients ◽  
Significant Difference

Background: When in emergency room there is no enough area left to serve or to admit the subsequent sick patients who may require urgent attention and observation the setting is called as the overcrowded emergency room. Due to overcrowded emergency department the quality of services provided by the staff and doctors is compromised ultimately patients with severe diseases are ignored and this may be one of the causes for causalities. Objective: To assess the daily burden and factors responsible for overcrowding at emergency department of tertiary care hospital of Karachi. Methodology: It was a cross sectional study conducted at tertiary care hospital of Karachi from October 2020 to January 2021. Data of patients coming to adult emergency department of either gender were collected.  Patients age <14 were excluded as these were referred to pediatric emergency department. Data collection was done according to Canadian emergency department triage and acuity scale (CTAS). Results: Total number (N) of patients who visited emergency department in study duration was 13434. The mean number of patients who visited ED was 141±13during our study duration. There was no any significant difference in presenting complaint. Delay in investigations was found to be a reason of prolong stay and overcrowding in ED in our setting. Conclusion: Overcrowding of patients in our ED of our setting was a common problem. The number of staff, doctors and beds were not matching the number of patient flow in the department. The main reason of prolong stay in ED was delay in investigations.

The impact of GP referrals on overcrowding in emergency departments and acute medicine

2021 ◽  
Vol 27 (2) ◽  
pp. 1-6
Author(s):  
Ayaz A Abbasi ◽  
Shams Khan ◽  
Victor Ameh ◽  
Ilyas Muhammad
Keyword(s):  
Emergency Department ◽  
Emergency Departments ◽  
Patient Flow ◽  
General Medicine ◽  
Service Evaluation ◽  
Urgent Care ◽  
Ambulatory Assessment ◽  
Acute Medicine ◽  
Number Of Patients ◽  
The Impact

Background/Aims A long-standing issue common to most emergency departments worldwide is overcrowding, and the UK is no exception. Overcrowding can have many adverse consequences, such as increased medical errors, decreased quality of care and poor patient outcomes. This service evaluation aimed to review the number of patients referred to acute specialties by their GPs and to evaluate the impact of these referrals on the flow of patients in and out of the emergency department and acute medicine. Methods GP referral letters were collected at an emergency department in Greater Manchester, England, between 15 May 2019 and 28 May 2019. A proforma was used by a consultant in acute medicine and a consultant in emergency medicine to evaluate each letter. Result A total of 139 GP referrals were received by the emergency department, of which 43 were to general medicine and 96 to other specialties. Of the latter, 54 cases were directed to the emergency department, 20 were directed to a different specialty and 23 did not have a specialty clearly specified. The majority of referrals were for gastrointestinal conditions or abdominal pain, with the next largest category being chest infections. Most of these patients were eventually seen in the trust's ambulatory assessment area to relieve pressure on the emergency department. Conclusions Planned and specific use of urgent care centres and ambulatory assessment areas can help to relieve pressure on emergency departments, but appropriate intervention at the primary care level is also necessary to improve patient flow.

Sign in / Sign up

Export Citation Format

Share Document