Associations of Emergency Department Length of Stay With Publicly Reported Quality‐of‐care Measures

abstractBackgroundTime-based-targets for emergency department length-of-stay were introduced in England in 2000; followed by Canada, Ireland, New Zealand, and Australia after emergency department crowding was associated with poor quality of care and increased mortality.ObjectivesThe aim of the systematic review was to evaluate qualitative literature to investigate how implementing time-based-targets for emergency department length-of-stay has influenced the quality of care of patients.MethodsSystematic review of qualitative studies that described knowledge, attitudes to or experiences regarding a time-based-target for emergency department length-of-stay. Searches were conducted in Cochrane library, Medline, Embase, CInAHL, Emerald, ABI/Inform, and Informit. Individual studies were evaluated using the Critical Appraisal Skills Programme tool. Individual study findings underwent thematic analysis. Confidence in findings was assessed using the Confidence in the Evidence from Reviews of Qualitative research approach.ResultsThe review included thirteen studies from four countries, incorporating 617 interviews. Themes identified were: quality of care, access block and overcrowding, patient experience, staff morale and workload, intrahospital and interdepartmental relationships, clinical education and training, gaming, and enablers and barriers to achieving targets. The confidence in findings is moderate or high for most themes. More patient and junior doctor perspectives are needed.ConclusionsEmergency time-based-targets have impacted on the quality of emergency patient care. The impact can be both positive and negative and successful implementation depends on whole hospital resourcing and engagement with targets.FundingThe Australasian College for Emergency Medicine provided administrative support for the study, no funding was received.RegistrationPROSPERO CRD42019107755 (prospective)

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Impact of the implementation of a fast-track on emergency department length of stay and quality of care indicators in the Champagne-Ardenne region: a before–after study

BMJ Open ◽

10.1136/bmjopen-2018-026200 ◽

2019 ◽

Vol 9 (6) ◽

pp. e026200 ◽

Cited By ~ 1

Author(s):

Jan Chrusciel ◽

Xavier Fontaine ◽

Arnaud Devillard ◽

Aurélien Cordonnier ◽

Lukshe Kanagaratnam ◽

...

Keyword(s):

Emergency Department ◽

Quality Of Care ◽

Length Of Stay ◽

Outcome Measures ◽

Fast Track ◽

Secondary Outcome ◽

Large Hospital ◽

Intervention Hospital ◽

Hospital Bed

ObjectivesWe aimed to evaluate the effect of the implementation of a fast-track on emergency department (ED) length of stay (LOS) and quality of care indicators.DesignAdjusted before–after analysis.SettingA large hospital in the Champagne-Ardenne region, France.ParticipantsPatients admitted to the ED between 13 January 2015 and 13 January 2017.InterventionImplementation of a fast-track for patients with small injuries or benign medical conditions (13 January 2016).Primary and secondary outcome measuresProportion of patients with LOS ≥4 hours and proportion of access block situations (when patients cannot access an appropriate hospital bed within 8 hours). 7-day readmissions and 30-day readmissions.ResultsThe ED of the intervention hospital registered 53 768 stays in 2016 and 57 965 in 2017 (+7.8%). In the intervention hospital, the median LOS was 215 min before the intervention and 186 min after the intervention. The exponentiated before–after estimator for ED LOS ≥4 hours was 0.79; 95% CI 0.77 to 0.81. The exponentiated before–after estimator for access block was 1.19; 95% CI 1.13 to 1.25. There was an increase in the proportion of 30 day readmissions in the intervention hospital (from 11.4% to 12.3%). After the intervention, the proportion of patients leaving without being seen by a physician decreased from 10.0% to 5.4%.ConclusionsThe implementation of a fast-track was associated with a decrease in stays lasting ≥4 hours without a decrease in access block. Further studies are needed to evaluate the causes of variability in ED LOS and their connections to quality of care indicators.

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Review article: Has the implementation of time‐based targets for emergency department length of stay influenced the quality of care for patients? A systematic review of quantitative literature

Emergency Medicine Australasia ◽

10.1111/1742-6723.13760 ◽

2021 ◽

Author(s):

Peter Jones ◽

Daniel Haustead ◽

Katie Walker ◽

Bridget Honan ◽

Vinay Gangathimmaiah ◽

...

Keyword(s):

Systematic Review ◽

Emergency Department ◽

Quality Of Care ◽

Length Of Stay ◽

Review Article

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"Best practices" guidelines can facilitate quality of care improvements in the emergency department

PsycEXTRA Dataset ◽

10.1037/e556882006-016 ◽

2000 ◽

Keyword(s):

Emergency Department ◽

Quality Of Care ◽

Best Practices

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National Trends in Emergency Department Care Processes for Acute Myocardial Infarction in the United States, 2005 to 2015

Journal of the American Heart Association ◽

10.1161/jaha.120.017208 ◽

2020 ◽

Vol 9 (20) ◽

Author(s):

Akshay Pendyal ◽

Craig Rothenberg ◽

Jean E. Scofi ◽

Harlan M. Krumholz ◽

Basmah Safdar ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Emergency Department ◽

Length Of Stay ◽

Real World ◽

The United States ◽

Emergency Department Care ◽

Care Processes ◽

Ed Visits

Background Despite investments to improve quality of emergency care for patients with acute myocardial infarction (AMI), few studies have described national, real‐world trends in AMI care in the emergency department (ED). We aimed to describe trends in the epidemiology and quality of AMI care in US EDs over a recent 11‐year period, from 2005 to 2015. Methods and Results We conducted an observational study of ED visits for AMI using the National Hospital Ambulatory Medical Care Survey, a nationally representative probability sample of US EDs. AMI visits were classified as ST‐segment–elevation myocardial infarction (STEMI) and non‐STEMI. Outcomes included annual incidence of AMI, median ED length of stay, ED disposition type, and ED administration of evidence‐based medications. Annual ED visits for AMI decreased from 1 493 145 in 2005 to 581 924 in 2015. Estimated yearly incidence of ED visits for STEMI decreased from 1 402 768 to 315 813. The proportion of STEMI sent for immediate, same‐hospital catheterization increased from 12% to 37%. Among patients with STEMI sent directly for catheterization, median ED length of stay decreased from 62 to 37 minutes. ED administration of antithrombotic and nonaspirin antiplatelet agents rose for STEMI (23%–31% and 10%–27%, respectively). Conclusions National, real‐world trends in the epidemiology of AMI in the ED parallel those of clinical registries, with decreases in AMI incidence and STEMI proportion. ED care processes for STEMI mirror evolving guidelines that favor high‐intensity antiplatelet therapy, early invasive strategies, and regionalization of care.

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