EP.WE.338Ambulatory Ultrasound Scans Reduce Inpatient Admissions During COVID-19: A Need for the Expansion of Ambulatory Services

Abstract Aim With the increased need to manage patients out of hospital during COVID-19, it was anticipated that need for ambulatory imaging would increase. This study aimed to assess the demand for ambulatory ultrasounds (US) during the COVID-19 pandemic and the impact on inpatient admissions. Methods A retrospective review of patients presenting to the Emergency Department (ED) between 12th July – 23rd August 2020 who required an US as first line imaging. Electronic Care Records were used to collect data regarding type of US i.e., inpatient, or ambulatory, time taken for ambulatory US and outcome after imaging. The same period in 2019 was assessed for comparison. Results In 2020, 100 patients required an US compared to 88 in 2019. 37% (37/100) of which were discharged for an ambulatory US, compared to 14.8% (13/88) in 2019 (p = 0.006). The average waiting time for an ambulatory US in 2019 was 2 days, this increased to 7 days in 2020. Following ambulatory US in 2020 43.2% (16/37) required further outpatient imaging or assessment; similar outcomes were seen in 2019 with 46.2% (6/13). Overall, there was a 150% increase in the use of ambulatory US, with a 26% decrease in admissions in 2020 vs. 2019. Conclusions There was a significant increase in the number of patients discharged from ED to undergo an ambulatory US resulting in reduced inpatient admissions. This increase in demand is reflected by the prolonged waiting time highlighting the requirement for expansion of ambulatory services to meet this clinical need.

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Leaving The Emergency Department Without Being Seen or Without Complete Treatment; A Study From Saudi Arabia

The Journal of Medicine, Law & Public Health ◽

10.52609/jmlph.v1i1.8 ◽

2021 ◽

Vol 1 (1) ◽

pp. 1-4

Author(s):

Mishal Abdulrahman Almarshady ◽

Sharafaldeen Bin Nafisah ◽

Yousef Almubarak ◽

Husam Althobyane

Keyword(s):

Emergency Department ◽

Saudi Arabia ◽

Mortality Rate ◽

Waiting Time ◽

Management Strategies ◽

Tertiary Hospital ◽

Health Concern ◽

Contributing Factors ◽

Number Of Patients ◽

The Impact

Background, The attitude of Leaving the emergency department (ED) without being seen or without completing treatment is attributed to prolonged waiting time. The impact of such behaviour and fate of such patients remain undetermined. Aim This study aimed to investigate the prevalence of Left Without Being Seen (LWBS) and Left Without Completing Treatment (LWCT), analyse the contributing factors for such behaviour and the mortality rate within one week of leaving the ED. Methods A retrospective observational study was performed in a tertiary hospital in Riyadh, Saudi Arabia, for three months. All adult patients of more than 14 years of age who visited the ED and LWBS or LWCT were included. Patients were seen by physicians and triaged-out, and those who were directed towards the outpatient clinic were excluded. Patients were asked about the reason for leaving, and their intention to return to the same ED again via call. Results The total number of LWBS and LWCT was 286 patients, with a response rate of 75%. The mean age was 45.8 years. About 46.6% sought medical help within seven days of leaving ED. However, the mortality rate was nil. Many patients (69.3%) reported their intention to revisit the same ED in the near future. A positive correlation was found between increasing age and admission within the same seven days’ period. Conclusion Prolonged waiting time is a public health concern that needs management strategies, the number of patients whom LWBS and LWCT require continuous monitoring and exploration.

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Exploring overcrowding trends in an inner city emergence department in the UK before and during COVID-19 epidemic

BMC Emergency Medicine ◽

10.1186/s12873-021-00438-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

J. Panovska-Griffiths ◽

J. Ross ◽

S. Elkhodair ◽

C. Baxter-Derrington ◽

C. Laing ◽

...

Keyword(s):

Emergency Department ◽

Waiting Time ◽

Number Of Patients ◽

Before And After ◽

Ed Overcrowding ◽

University College London ◽

Flow Through ◽

Indirect Impacts ◽

The Uk ◽

The Impact

Abstract Background The COVID-19 pandemic and the associated lockdowns have caused significant disruptions across society, including changes in the number of emergency department (ED) visits. This study aims to investigate the impact of three pre-COVID-19 interventions and of the COVID-19 UK-epidemic and the first UK national lockdown on overcrowding within University College London Hospital Emergency Department (UCLH ED). The three interventions: target the influx of patients at ED (A), reduce the pressure on in-patients’ beds (B) and improve ED processes to improve the flow of patents out from ED (C). Methods We collected overcrowding metrics (daily attendances, the proportion of people leaving within 4 h of arrival (four-hours target) and the reduction in overall waiting time) during 01/04/2017–31/05/2020. We then performed three different analyses, considering three different timeframes. The first analysis used data 01/04/2017–31/12–2019 to calculate changes over a period of 6 months before and after the start of interventions A-C. The second and third analyses focused on evaluating the impact of the COVID-19 epidemic, comparing the first 10 months in 2020 and 2019, and of the first national lockdown (23/03/2020–31/05/2020). Results Pre-COVID-19 all interventions led to small reductions in waiting time (17%, p < 0.001 for A and C; an 9%, p = 0.322 for B) but also to a small decrease in the number of patients leaving within 4 h of arrival (6.6,7.4,6.2% respectively A-C,p < 0.001). In presence of the COVID-19 pandemic, attendance and waiting time were reduced (40% and 8%; p < 0.001), and the number of people leaving within 4 h of arrival was increased (6%,p < 0.001). During the first lockdown, there was 65% reduction in attendance, 22% reduction in waiting time and 8% increase in number of people leaving within 4 h of arrival (p < 0.001). Crucially, when the lockdown was lifted, there was an increase (6.5%,p < 0.001) in the percentage of people leaving within 4 h, together with a larger (12.5%,p < 0.001) decrease in waiting time. This occurred despite the increase of 49.6%(p < 0.001) in attendance after lockdown ended. Conclusions The mixed results pre-COVID-19 (significant improvements in waiting time with some interventions but not improvement in the four-hours target), may be due to indirect impacts of these interventions, where increasing pressure on one part of the ED system affected other parts. This underlines the need for multifaceted interventions and a system-wide approach to improve the pathway of flow through the ED system is necessary. During 2020 and in presence of the COVID-19 epidemic, a shift in public behaviour with anxiety over attending hospitals and higher use of virtual consultations, led to notable drop in UCLH ED attendance and consequential curbing of overcrowding. Importantly, once the lockdown was lifted, although there was an increase in arrivals at UCLH ED, overcrowding metrics were reduced. Thus, the combination of shifted public behaviour and the restructuring changes during COVID-19 epidemic, maybe be able to curb future ED overcrowding, but longer timeframe analysis is required to confirm this.

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Applying quality improvement principles to improve accident and emergency department overcrowding and flow in Rwanda: a case study

Journal of Hospital Administration ◽

10.5430/jha.v4n5p47 ◽

2015 ◽

Vol 4 (5) ◽

pp. 47 ◽

Cited By ~ 3

Author(s):

Jean Claude Byiringiro ◽

Rex Wong ◽

Caroline Davis ◽

Jeffery Williams ◽

Joseph Becker ◽

...

Keyword(s):

Emergency Department ◽

Quality Improvement ◽

Success Factors ◽

Low Cost ◽

Post Intervention ◽

Triage System ◽

Accident And Emergency ◽

Number Of Patients ◽

Accident And Emergency Department ◽

The Impact

Few case studies exist related to hospital accident and emergency department (A&E) quality improvement efforts in lowerresourced settings. We sought to report the impact of quality improvement principles applied to A&E overcrowding and flow in the largest referral and teaching hospital in Rwanda. A pre- and post-intervention study was conducted. A linked set of strategies included reallocating room space based on patient/visitor demand and flow, redirecting traffic, establishing a patient triage system and installing white boards to facilitate communication. Two months post-implementation, the average number of patients boarding in the A&E hallways significantly decreased from 28 (pre-intervention) to zero (post-intervention), p < .001. Foot traffic per dayshift hour significantly decreased from 221 people to 160 people (28%, p < .001), and non-A&E related foot traffic decreased from 81.4% to 36.3% (45% decrease, p < .001). One hundred percent of the A&E patients have been formally triaged since the implementation of the newly established triage system. Our project used quality improvement principles to reduce the number of patients boarding in the hallways and to decrease unnecessary foot traffic in the A&E department with little investment from the hospital. Key success factors included a collaborative multidisciplinary project team, strong internal champions, data-driven analysis, evidence-based interventions, senior leadership support, and rapid application of initial implementation learnings. Results to date show the application of quality improvement principles can help hospitals in resource-limited settings improve quality of care at relatively low cost.

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845. Impact of the COVID-19 Pandemic on Routine HIV Screening in an Emergency Department

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.1040 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S513-S513

Author(s):

Elizabeth A Aguilera ◽

Gilhen Rodriguez ◽

Gabriela P Del Bianco ◽

Gloria Heresi ◽

James Murphy ◽

...

Keyword(s):

Emergency Department ◽

Screening Program ◽

Medical Center ◽

Hiv Infections ◽

Hiv Screening ◽

Opt Out ◽

Number Of Patients ◽

Confirmatory Tests ◽

Routine Hiv Screening ◽

The Impact

Abstract Background The Emergency Department (ED) at Memorial Hermann Hospital (MHH) - Texas Medical Center (TMC), Houston, Texas has a long established screening program targeted at detection of HIV infections. The impact of the COVID-19 pandemic on this screening program is unknown. Methods The Routine HIV screening program includes opt-out testing of all adults 18 years and older with Glasgow score > 9. HIV 4th generation Ag/Ab screening, with reflex to Gennius confirmatory tests are used. Pre-pandemic (March 2019 to February 2020) to Pandemic period (March 2020 to February 2021) intervals were compared. Results 72,929 patients visited MHH_ED during the pre-pandemic period and 57,128 in the pandemic period, a 22% decline. The number of patients tested for HIV pre-pandemic was 9433 and 6718 pandemic, a 29% decline. When the pandemic year was parsed into first and last 6 months interval and compared to similar intervals in the year pre pandemic, 39% followed by 16% declines in HIV testing were found. In total, 354 patients were HIV positives, 209, (59%) in the pre-pandemic and 145 (41%) in the pandemic period.The reduction in new HIV infections found was directly proportional to the decline in patients visiting the MHH-ED where the percent of patients HIV positive was constant across intervals (2.21% vs 2.26%). Demographic and outcome characteristics were constant across the compared intervals. Conclusion The COVID -19 pandemic reduced detection of new HIV infections by screening in direct proportion to the reduction in MHH-ED patient visits. The impact of COVID-19 pandemic decreased with duration of the pandemic. Disclosures All Authors: No reported disclosures

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Evaluating alcohol intoxication management services: the EDARA mixed-methods study

Health Services and Delivery Research ◽

10.3310/hsdr08240 ◽

2020 ◽

Vol 8 (24) ◽

pp. 1-214 ◽

Cited By ~ 1

Author(s):

Simon C Moore ◽

Davina Allen ◽

Yvette Amos ◽

Joanne Blake ◽

Alan Brennan ◽

...

Keyword(s):

Emergency Department ◽

Emergency Departments ◽

Alcohol Intoxication ◽

Ethnographic Study ◽

Acute Alcohol Intoxication ◽

Front Line ◽

Night Time ◽

Number Of Patients ◽

The Impact ◽

Management Services

Background Front-line health-care services are under increased demand when acute alcohol intoxication is most common, which is in night-time environments. Cities have implemented alcohol intoxication management services to divert the intoxicated away from emergency care. Objectives To evaluate the effectiveness, cost-effectiveness and acceptability to patients and staff of alcohol intoxication management services and undertake an ethnographic study capturing front-line staff’s views on the impact of acute alcohol intoxication on their professional lives. Methods This was a controlled mixed-methods longitudinal observational study with an ethnographic evaluation in parallel. Six cities with alcohol intoxication management services were compared with six matched control cities to determine effects on key performance indicators (e.g. number of patients in the emergency department and ambulance response times). Surveys captured the impact of alcohol intoxication management services on the quality of care for patients in six alcohol intoxication management services, six emergency departments with local alcohol intoxication management services and six emergency departments without local alcohol intoxication management services. The ethnographic study considered front-line staff perceptions in two cities with alcohol intoxication management services and one city without alcohol intoxication management services. Results Alcohol intoxication management services typically operated in cities in which the incidence of acute alcohol intoxication was greatest. The per-session average number of attendances across all alcohol intoxication management services was low (mean 7.3, average minimum 2.8, average maximum 11.8) compared with the average number of emergency department attendances per alcohol intoxication management services session (mean 78.8), and the number of patients diverted away from emergency departments, per session, required for services to be considered cost-neutral was 8.7, falling to 3.5 when ambulance costs were included. Alcohol intoxication management services varied, from volunteer-led first aid to more clinically focused nurse practitioner services, with only the latter providing evidence for diversion from emergency departments. Qualitative and ethnographic data indicated that alcohol intoxication management services are acceptable to practitioners and patients and that they address unmet need. There was evidence that alcohol intoxication management services improve ambulance response times and reduce emergency department attendance. Effects are uncertain owing to the variation in service delivery. Limitations The evaluation focused on health service outcomes, yet evidence arose suggesting that alcohol intoxication management services provide broader societal benefits. There was no nationally agreed standard operating procedure for alcohol intoxication management services, undermining the evaluation. Routine health data outcomes exhibited considerable variance, undermining opportunities to provide an accurate appraisal of the heterogenous collection of alcohol intoxication management services. Conclusions Alcohol intoxication management services are varied, multipartner endeavours and would benefit from agreed national standards. Alcohol intoxication management services are popular with and benefit front-line staff and serve as a hub facilitating partnership working. They are popular with alcohol intoxication management services patients and capture previously unmet need in night-time environments. However, acute alcohol intoxication in emergency departments remains an issue and opportunities for diversion have not been entirely realised. The nurse-led model was the most expensive service evaluated but was also the most likely to divert patients away from emergency departments, suggesting that greater clinical involvement and alignment with emergency departments is necessary. Alcohol intoxication management services should be regarded as fledgling services that require further work to realise benefit. Future work Research could be undertaken to determine if a standardised model of alcohol intoxication management services, based on the nurse practitioner model, can be developed and implemented in different settings. Future evaluations should go beyond the health service and consider outcomes more generally, especially for the police. Future work on the management of acute alcohol intoxication in night-time environments could recognise the partnership between health-care, police and ambulance services and third-sector organisations in managing acute alcohol intoxication. Trial registration Current Controlled Trials ISRCTN63096364. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 24. See the NIHR Journals Library website for further project information.

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Measuring and Analyzing Waiting Time Indicators of Patients’ Admitted in Emergency Department: A Case Study

Global Journal of Health Science ◽

10.5539/gjhs.v8n1p143 ◽

2015 ◽

Vol 8 (1) ◽

pp. 143 ◽

Cited By ~ 6

Author(s):

Saeed Amina ◽

Ahmad Barrati ◽

Jamil Sadeghifar ◽

Marzeyh Sharifi ◽

Zahra Toulideh ◽

...

Keyword(s):

Emergency Department ◽

Waiting Time ◽

Waiting Times ◽

Hospital Data ◽

Governance System ◽

Cross Sectional ◽

Average Waiting Time ◽

Study Population

BACKGROUND & AIMS: Measuring and analyzing of provided services times in Emergency Department is the way to improves quality of hospital services. The present study was conducted with aim measuring and analyzing patients waiting time indicators in Emergency Department in a general hospital in Iran. MATERIAL & METHODS: This cross-sectional, observational study was conducted during April to September 2012. The study population consisted of 72 patients admitted to the Emergency Department at Baharlo hospital. Data collection was carried out by workflow forms. Data were analyzed by t. test and ANOVA. RESULTS: The average waiting time for patients from admission to enter the triage 5 minutes, the average time from triage to physician visit 6 minute and the average time between examinations to leave ED was estimated 180 minutes. The total waiting time in the emergency department was estimated at about 210 minutes. The significant correlation between marital status of patients (P=0.03), way of arrive to ED (P=0.02) and type of shift work (P=0.01) with studied time indicators were observed. CONCLUSION: According to results and comparing with similar studies, the average waiting time of patients admitted to the studied hospital is appropriate. Factors such as: Utilizing clinical governance system and attendance of resident Emergency Medicine Specialist have performed an important role in reducing of waiting times in ED.

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Impact of streaming "fast track" emergency department patients

Australian Health Review ◽

10.1071/ah060525 ◽

2006 ◽

Vol 30 (4) ◽

pp. 525 ◽

Cited By ~ 50

Author(s):

Debra O'Brien ◽

Aled Williams ◽

Kerrianne Blondell ◽

George A Jelinek

Keyword(s):

Emergency Department ◽

Length Of Stay ◽

Waiting Time ◽

Fast Track ◽

Average Length ◽

Waiting Times ◽

Relative Reduction ◽

Average Waiting Time ◽

Discharged Patients ◽

Track Area

Objective: Fast track systems to stream emergency department (ED) patients with low acuity conditions have been introduced widely, resulting in reduced waiting times and lengths of stay for these patients. We aimed to prospectively assess the impact on patient flows of a fast track system implemented in the emergency department of an Australian tertiary adult teaching hospital which deals with relatively few low acuity patients. Methods: During the 12-week trial period, patients in Australasian Triage Scale (ATS) categories 3, 4 and 5 who were likely to be discharged were identified at triage and assessed and treated in a separate fast track area by ED medical and nursing staff rostered to work exclusively in the area. Results: The fast track area managed 21.6% of all patients presenting during its hours of operation. There was a 20.3% (?18 min; 95%CI, ?26 min to ?10 min) relative reduction in the average waiting time and an 18.0% (?41 min; 95%CI, ?52 min to ?30 min) relative reduction in the average length of stay for all discharged patients compared with the same period the previous year. Compared with the 12-week period before the fast track trial, there was a 3.4% (?2.1 min; 95%CI, ?8 min to 4 min) relative reduction in the average waiting time and a 9.7% (?20 min; 95%CI, ?31 min to ?9 min) relative reduction in the average length of stay for all discharged patients. There was no increase in the average waiting time for admitted patients. This was despite major increases in throughput and access block in the study period. Conclusion: Streaming fast track patients in the emergency department of an Australian tertiary adult teaching hospital can reduce waiting times and length of stay for discharged patients without increasing waiting times for admitted patients, even in an ED with few low acuity patients.

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A study on the impact of prioritising emergency department arrivals on the patient waiting time

Health Care Management Science ◽

10.1007/s10729-018-9447-5 ◽

2018 ◽

Vol 22 (4) ◽

pp. 589-614 ◽

Cited By ~ 1

Author(s):

Ellen Van Bockstal ◽

Broos Maenhout

Keyword(s):

Emergency Department ◽

Waiting Time ◽

Patient Waiting Time ◽

The Impact ◽

Patient Waiting

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Quick diagnostic unit integrated in an emergency department setting reduces medical admissions – an observational study

Journal of Hospital Administration ◽

10.5430/jha.v3n3p17 ◽

2013 ◽

Vol 3 (3) ◽

pp. 17 ◽

Cited By ~ 1

Author(s):

Dan Brun Petersen ◽

Thomas Andersen Schmidt

Keyword(s):

Internal Medicine ◽

Emergency Department ◽

General Medicine ◽

University Hospital ◽

First Year ◽

Special Focus ◽

Diagnostic Study ◽

Diagnostic Unit ◽

Number Of Patients ◽

The Impact

Background: Hospitals in countries with public health systems have recently adopted organizational changes to improve efficiency and resource allocation, and reducing inappropriate hospitalizations has been established as an important goal, as well as avoiding or buffering overcrowding in Emergency Departments (EDs). Aims: Our goal was to describe the impact of a Quick Diagnostic Unit established on January 1, 2012, integrated in an ED setting in a Danish public university hospital following its function for the first year. Design: Observational, descriptive and comparative study. Methods: Our sample comprised the total number of patients being admitted and discharged from the Department of Internal Medicine in 2011 and 2012, with special focus on the General Medicine Ward. Results: Compared with 2011 the establishment of the Quick Diagnostic Unit integrated in the Emergency Department resulted in the admittance and discharge of fewer patients (40%; p < .0001) to the hospital’s General Medicine Ward and 11.6% (p < .0001) fewer patients in the whole Department of Internal Medicine. Conclusions: A Quick Diagnostic Unit integrated in an ED setting represents a useful and fast track model for the diagnostic study and treatment of patients with simple internal medicine ailments, and also serves as a buffer for overcrowding of the ED.

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An interrupted time-series analysis of the impact of emergency department reconfiguration on regional emergency department trolley numbers in Ireland from 2005 to 2015

BMJ Open ◽

10.1136/bmjopen-2019-029261 ◽

2019 ◽

Vol 9 (9) ◽

pp. e029261 ◽

Cited By ~ 2

Author(s):

Brenda Lynch ◽

John Browne ◽

Claire Mary Buckley ◽

Orla Healy ◽

Paul Corcoran ◽

...

Keyword(s):

Emergency Department ◽

Time Series ◽

Time Series Analysis ◽

Interrupted Time Series Analysis ◽

Series Analysis ◽

North East ◽

The North ◽

Number Of Patients ◽

Geographical Regions ◽

The Impact

ObjectivesTo understand the impact of emergency department (ED) reconfiguration on the number of patients waiting for hospital beds on trolleys in the remaining EDs in four geographical regions in Ireland using time-series analysis.SettingEDs in four Irish regions; the West, North-East, South and Mid-West from 2005 to 2015.ParticipantsAll patients counted as waiting on trolleys in an ED for a hospital bed in the study hospitals from 2005 to 2015.InterventionThe system intervention was the reconfiguration of ED services, as determined by the Department of Health and Health Service Executive. The timing of these interventions varied depending on the hospital and region in question.ResultsThree of the four regions studied experienced a significant change in ED trolley numbers in the 12-month post-ED reconfiguration. The trend ratio before and after the intervention for these regions was as follows: North-East incidence rate ratio (IRR) 2.85 (95% CI 2.04 to 3.99, p<0.001), South IRR 0.68 (95% CI 0.51 to 0.89, p=0.006) and the Mid-West IRR 0.03 (95% 1.03 to 2.03, p=0.03). Two of these regions, the South and the Mid-West, displayed a convergence between the observed and expected trolley numbers in the 12-month post-reconfiguration. The North-East showed a much steeper increase, one that extended beyond the 12-month period post-ED reconfiguration.ConclusionsFindings suggest that the impacts of ED reconfiguration on regional level ED trolley trends were either non-significant or caused a short-term shock which converged on the pre-reconfiguration trend over the following 12 months. However, the North-East is identified as an exception due to increased pressures in one regional hospital, which caused a change in trend beyond the 12-month post reconfiguration.

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