scholarly journals Decreasing Length of Stay in the Emergency Department With a Split Emergency Severity Index 3 Patient Flow Model

2013 ◽  
Vol 20 (11) ◽  
pp. 1171-1179 ◽  
Author(s):  
Rajiv Arya ◽  
Grant Wei ◽  
Jonathan V. McCoy ◽  
Jody Crane ◽  
Pamela Ohman-Strickland ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Flow Model ◽  
Patient Flow ◽  
Severity Index ◽  
Emergency Severity Index

Validity of the Emergency Severity Index in a Finnish Emergency Department 

2021 ◽  
Author(s):  
Kirsi Maria Kemp ◽  
Janne Alakare ◽  
Minna Kätkä ◽  
Mitja Lääperi ◽  
Lasse Lehtonen ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Hospital Admissions ◽  
Oldest Old ◽  
Statistical Significance ◽  
Age Groups ◽  
Severity Index ◽  
Emergency Severity Index ◽  
High Dependency ◽  
Secondary Outcomes

Abstract Background: The purpose of acuity assessment, triage, in the emergency department is to recognize critically ill patients and to allocate resources. The Emergency Severity Index (ESI) is used widely around the world and has been shown to be at least as good as other 5-level assessment instruments. In this study, we assess validity of the ESI triage system in a Finnish Emergency department for predicting 30-day mortality as primary outcome and hospital admissions, high dependency unit or intensive care unit admissions as secondary outcomes, and efficiency for predicting emergency department length-of-stay and utilized resources as secondary outcomes. Methods: We collected data of all adult patient visits to the emergency department during a one-month period. The data was analyzed for the primary and secondary outcomes stratified by age: younger adults (18-64 years), older adults (65-79 years) and oldest old (>80 years). Results: Of the 5909 visits, 5511 were eligible for analysis, 2725 of them men. Median age was 59 years; 30-day mortality was 150 (2.7%). In all age groups, 30-day mortality was consecutively higher with statistical significance between each step from between categories 1 to 3. There were 2274 admissions, 190 of the to HDU or ICU.  Hospital admission rates were significantly higher between each step between categories 2 to 4 for all adults. HDU/ICU admissions were higher in category 2 than in category 3 in all age groups. Resource utilization was higher in category 3 than in category 4; categories 4 and 5 differed only in the younger adult group. Most patients in categories 4 and 5 required ≥2 and 0 resource, respectively. Median length of stay at the emergency department was 3h 47min. For all patients ED-LOS varied without linearity; LOS was longest in category 3 in all age groups. Conclusions: ESI seems to be a valid tool for acuity assessment in all age groups in our population: it recognized severely ill patients by predicting mortality and hospital admissions in the higher triage categories in all age groups. Having failed to predict both resource consumption and ED-LOS, ESI was not associated with efficiency in our population.

scholarly journals https://soar.usa.edu/scholprojects/60/

2021 ◽  
Author(s):  
◽  
Stephanie Carpenter
Keyword(s):  
Patient Satisfaction ◽  
Length Of Stay ◽  
Patient Flow ◽  
Severity Index ◽  
Urgent Care ◽  
Wait Times ◽  
Emergency Severity Index ◽  
Care Clinic ◽  
Patient Satisfaction Scores ◽  
Urgent Care Clinic

Practice Problem: Urgent care clinics provide care to patients with non-life-threatening illnesses or injuries and are found to be less expensive and more convenient than emergency departments. As urgent care clinics are growing in popularity so are the patient wait times and overall length of stay times. PICOT: The PICOT question that guided this project was in urgent care clinic patients (P), how does utilizing the Emergency Severity Index (ESI) as a patient triage tool (I) compared to using no patient triage tool (C) affect the patient flow and patient wait times (O) within 13 weeks. Evidence: Evidence search with applicable inclusion and exclusion material yielded six acceptable articles. The utilization of the Emergency Severity Index (ESI) triage tool decreased patient wait times and overall length of stay times leading to increased patient satisfaction. Intervention: The ESI triage tool was implemented in the urgent care clinic so that patients were evaluated in a timely manner based on his or her ESI score. Patient wait times, length of stay times, and patient satisfaction scores were recorded. Outcome: The overall results demonstrated that short length of stay times resulted in improved patient satisfaction scores. In addition, shortened patient to provider times resulted in higher patient satisfaction scores. Conclusion: A significant impact was obtained in the urgent care clinic by implementing the use of the ESI triage tool. By utilizing the ESI triage tool, patient wait times and length of stay times decreased leading to improved patient satisfaction scores for the clinic.

scholarly journals The Sydney triage to admission risk tool (START) to improve patient flow in an emergency department: a model of care implementation pilot study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Anja Ebker-White ◽  
Kendall J. Bein ◽  
Saartje Berendsen Russell ◽  
Michael M. Dinh
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Patient Flow ◽  
Intervention Group ◽  
Control Sample ◽  
Patient Admission ◽  
Implementation Study ◽  
Model Of Care ◽  
Early Assessment ◽  
Pilot Implementation

Abstract Background The Sydney Triage to Admission Risk Tool (START) is a validated clinical analytics tool designed to estimate the probability of in-patient admission based on Emergency Department triage characteristics. Methods This was a single centre pilot implementation study using a matched case control sample of patients assessed at ED triage. Patients in the intervention group were identified at triage by the START tool as likely requiring in-patient admission and briefly assessed by an ED Consultant. Bed management were notified of these patients and their likely admitting team based on senior early assessment. Matched controls were identified on the same day of presentation if they were admitted to the same in-patient teams as patients in the intervention group and same START score category. Outcomes were ED length of stay and proportion of patients correctly classified as an in-patient admission by the START tool. Results One hundred and thirteen patients were assessed using the START-based model of care. When compared with matched control patients, this intervention model of care was associated with a significant reduction in ED length of stay [301 min (IQR 225–397) versus 423 min (IQR 297–587) p < 0.001] and proportion of patients meeting 4 h length of stay thresholds increased from 24 to 45% (p < 0.001). Conclusion In this small pilot implementation study, the START tool, when used in conjunction with senior early assessment was associated with a reduction in ED length of stay. Further controlled studies are now underway to further examine its utility across other ED settings.

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

2009 ◽  
Vol 16 (7) ◽  
pp. 597-602 ◽  
Author(s):  
Ray Lucas ◽  
Heather Farley ◽  
Joseph Twanmoh ◽  
Andrej Urumov ◽  
Nils Olsen ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Patient Flow ◽  
Emergency Department Patient

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

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.

scholarly journals Weight-for-Age Percentile as a Pediatric Predictor of Emergency Department Outcome

2019 ◽  
Vol 6 ◽  
pp. 2333794X1987703
Author(s):  
Vishal Naik ◽  
Cheryl Lefaiver ◽  
Avni Dervishi ◽  
Vinod Havalad
Keyword(s):  
Emergency Department ◽  
Severity Index ◽  
Normal Weight ◽  
Independent Effect ◽  
Key Factors ◽  
Emergency Severity Index ◽  
Logistic Regression Models ◽  
Younger Age ◽  
Ed Visits ◽  
Weight For Age

This study is a retrospective cohort study that examines the association between weight-for-age percentile and pediatric admission incidence from the emergency department (ED) for all diagnoses. The charts of 1432 pediatric patients under 18 years with ED visits from 2013 to 2015 at a tertiary children’s hospital were reviewed. Analyses of subject age/weight stratifications were performed, along with ED disposition, reason for visit, and Emergency Severity Index (ESI). Multivariable logistic regression models were used to evaluate the independent effect of weight-for-age percentile on ED disposition while controlling for age, ESI, and reason for visit. Underweight subjects were more likely to be admitted than their normal weight counterparts when analyzed overall (odds ratio [OR] = 2.58, P < .01) and by age: less than 2.0 years of age (OR = 2.04, P = .033), between 2.01 and 6.0 years of age (OR = 8.60, P = .004), and between 6.01 and 13.0 years of age (OR = 3.83, P = .053). Younger age (OR = 0.935, P < .001) and higher acuity (OR = 3.49, P < .001) were also significant predictors of admission. No significant associations were found between weight and likelihood of admission for patients older than 13.01 years or between overweight/obese weight categories and admission for any age subgroups. This study suggests that underweight children younger than 13 years are at higher risk to be admitted from the ED than their normal weight, overweight, and obese counterparts. Even when controlling for other key factors, such as the ESI, a lower weight-for-age percentile was a reliable predictor of hospitalization.

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