Improving before-noon discharges in the acute medical ward

2021 ◽  
pp. 201010582110111
Author(s):  
Siti Khadijah Binte Zainuddin ◽  
Tharmmambal Balakrishnan
Keyword(s):  
Emergency Department ◽  
Multidisciplinary Team ◽  
Discharge Rate ◽  
Patient Flow ◽  
Early Discharge ◽  
Medical Ward ◽  
Discharge Process ◽  
Next Of Kin ◽  
Patient Transfers ◽  
Admission Time

Background: Mismatch in admission and discharge rates with poor coordination of bed availability to prepare for peak admission time do not favor patient flow in any healthcare situation. In order to meet the admissions demand from the emergency department, early discharge is advocated. Aim: The purpose of this study was to increase the 11:30 discharge rate in the acute medical ward to 20% within 5 months in order to facilitate patient transfers from the emergency department. Method and intervention: A nurse-led multidisciplinary team discussion at 10:00 was formed empowering nurses and aims to prioritize early discharges or transfer patients who require a longer stay in the hospital. The indication of expected discharge date was determined by team doctors on either day 1 or 2 of admission, to facilitate and prioritize allied health intervention or even prescription processing. Physical transfer to the discharge lounge was to occur earlier, awaiting preparation of prescription and documentation. Dedicated nursing staff who manage the discharge lounge processes, were to ensure the transfers and care arrangements to be smooth and coordinated with enhanced communication to next of kin. Results: The overall median rate for discharges before 11:30 in the acute medical ward was at 17%, compared to baseline median discharge rate of 12% ( p=0.05) and evening discharges that remained. With the implementation of a framework for multidisciplinary team discussion, the mean time spent on multidisciplinary team reduced to 40 min from the pre-intervention stage, ranging approximately 57–68 min. Conclusion: The discharge process is complex and requires multidisciplinary team collaboration and coordination. This project also created an opportunity for more relevant project targeting evening discharges that addresses another emergency department peak admission time.

scholarly journals The Impact of a Concierge Medicine Model on Door to Doctor Time and Patient Flow in an Urban Emergency Department

2020 ◽  
Vol Volume 12 ◽  
pp. 13-18
Author(s):  
Asher L Mandel ◽  
Thomas Bove ◽  
Amisha D Parekh ◽  
Paris Datillo ◽  
Joseph Bove Jr ◽  
...  
Keyword(s):  
Emergency Department ◽  
Patient Flow ◽  
The Impact ◽  
Urban Emergency Department

Impact of 24/7 Onsite Emergency Radiology Staff Coverage on Emergency Department Workflow

2021 ◽  
pp. 084653712110238
Author(s):  
Francesco Macri ◽  
Bonnie T. Niu ◽  
Shannon Erdelyi ◽  
John R. Mayo ◽  
Faisal Khosa ◽  
...  
Keyword(s):  
Emergency Department ◽  
Major Trauma ◽  
Patient Flow ◽  
Interrupted Time Series ◽  
Trauma Patients ◽  
Linear Regression Models ◽  
High Acuity ◽  
Time Series Approach ◽  
Comparison Series ◽  
The Impact

Purpose: Assess the impact of 24/7/365 emergency trauma radiology (ETR) coverage on Emergency Department (ED) patient flow in an urban, quaternary-care teaching hospital. Methods: Patient ED visit and imaging information were extracted from the hospital patient care information system for 2008 to 2018. An interrupted time-series approach with a comparison group was used to study the impact of 24/7/365 ETR on average monthly ED length of stay (ED-LOS) and Emergency Physician to disposition time (EP-DISP). Linear regression models were fit with abrupt and permanent interrupts for 24/7/365 ETR, a coefficient for comparison series and a SARIMA error term; subgroup analyses were performed by patient arrival time, imaging type and chief complaint. Results: During the study period, there were 949,029 ED visits and 739,796 diagnostic tests. Following implementation of 24/7/365 coverage, we found a significant decrease in EP-DISP time for patients requiring only radiographs (-29 min;95%CI:-52,-6) and a significant increase in EP-DISP time for major trauma patients (46 min;95%CI:13,79). No significant change in patient throughput was observed during evening hours for any patient subgroup. For overnight patients, there was a reduction in EP-DISP for patients with symptoms consistent with stroke (-78 min;95%CI:-131,-24) and for high acuity patients who required imaging (-33 min;95%CI:-57,-10). Changes in ED-LOS followed a similar pattern. Conclusions: At our institution, 24/7/365 in-house ETR staff radiology coverage was associated with improved ED flow for patients requiring only radiographs and for overnight stroke and high acuity patients. Major trauma patients spent more time in the ED, perhaps reflecting the required multidisciplinary management.

scholarly journals 688 Rapid Implementation of Virtual Fracture Clinic During COVID 19 Reduces Both Face-To-Face Appointments and Facilitates Rapid Feedback and Education to Be Delivered to The Emergency Department

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
T Havenhand ◽  
L Hoggett ◽  
A Bhutta
Keyword(s):  
Emergency Department ◽  
Patient Flow ◽  
Prospective Data ◽  
Fracture Clinic ◽  
Face To Face ◽  
Return Rates ◽  
Acute Hospitals ◽  
Virtual Fracture Clinic ◽  
Improve Patient

Abstract Introduction COVID-19 has dictated a shift towards virtual clinics. Pennine Acute Hospitals NHS Trust serves over a million patients with a significant number of face-to-face fracture clinics. Introduction of a Virtual Fracture Clinic (VFC) reduces hospital return rates and improves patient experience. The referral data can be used to give immediate monthly feedback to the referring department to further improving patient flow. Method Prospective data was collected for all referrals to VFC during March 2020. Data included referral diagnosis, actual diagnosis, referrers grade, and final outcome. Results 630 referrals were made to VFC. 347 (55%) of those referrals were directly discharged without the need for physical consultation. Of these 114 (32%) were injuries which can be discharged by the Emergency Department with an advice leaflet using existing pathways. Of the remaining discharges 102 (29%) were query fractures or sprains; and 135 (39%) were minor fractures; which needed only advice via a letter and no face to face follow up. Conclusions Implementation of VFC leads to a decrease in physical appointments by 55% saving 347 face to face appointments. The new system has also facilitated effective audit of referrals in order to further improve patient flow from the Emergency Department via feedback mechanisms and education.

scholarly journals 144 The Use of a Multidisciplinary Team Discharge “Huddle” to Improve Patient Flow and Planning

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii1-iii16
Author(s):  
Mary Randles ◽  
Sylvia Hickey ◽  
Susanne Cotter ◽  
Carmel Walsh ◽  
Kieran O'Connor ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Patient Care ◽  
Multidisciplinary Team ◽  
Older Persons ◽  
Patient Flow ◽  
Geriatric Medicine ◽  
City Centre ◽  
Nurse Specialist ◽  
Complex Care ◽  
Clinical Nurse

Abstract Background Patient flow, the movement of patients is an integral part of the patient care pathway. With the goal of improving overall patient care and discharge planning, a hospital wide, multidisciplinary team based, patient discharge meeting or ‘HUDDLE’ was devised with the goal of facilitating onward care planning for all inpatients especially those with complex discharge needs in a city centre teaching hospital. Methods The patient flow huddle has evolved to include a Patient Flow Clinical Nurse Manager, Bed Manager, Medicine for Older Persons Clinical Nurse Specialist, Physiotherapist/Occupational Therapist, Consultant Geriatrician and Geriatric Medicine Registrar. Each team in the hospital are requested to attend at least twice a week. Predicted discharge dates are established. Teams discuss patients who have a requirement for rehabilitation, either short-term or complex rehabilitation and patients over 65 years who may need review from Older Persons Services .We sought to optimise issues including housing, home care packages, interim home supports, community intervention team referrals, integrated care and Nursing Home Support Scheme applications. Results There were 3918 Emergency Department presentations by adults over 75 in 2018 and 2113 admissions (3704, 2081 respectively in 2017). Accuracy for discharge within one day of PDD ranged from 52.5% (Jan) to 72.6 % (Nov). The average length of stay was 6.2days (SD 0.47). 172 patients (84 female, 88 male) were admitted for slow stream rehabilitation (median length of stay 30 days). Conclusion Rather than using a negative view of older adults as potential ‘bed blockers’, the discharge huddle allowed a pro-active approach to assist medical and surgical teams in the management and re-enablement of patients with complex care needs. Early identification of such patients with complex care and discharge needs allowed greater focus on appropriate planning earlier in the patient’s hospital journey.

Simulation of a Hospital Disaster Plan: A Virtual, Live Exercise

2008 ◽  
Vol 23 (4) ◽  
pp. 346-353 ◽  
Author(s):  
Jeffrey M. Franc-Law ◽  
Michael Bullard ◽  
F. Della Corte
Keyword(s):  
Emergency Department ◽  
Patient Flow ◽  
Learning Experience ◽  
Significant Degree ◽  
Primary Objective ◽  
Simulated Patients ◽  
Disaster Plan ◽  
Actual Patient ◽  
Patient Database ◽  
Rate Limiting

AbstractIntroduction:Currently, there is no widely available method to evaluate an emergency department disaster plan. Creation of a standardized patient data- base and the use of a virtual, live exercise may lead to a standardized and reproducible method that can be used to evaluate a disaster plan.Purpose:A virtual, live exercise was designed with the primary objective of evaluating a hospital's emergency department disaster plan. Education and training of participants was a secondary goal.Methods:A database (disastermed.ca) of histories, physical examination findings, and laboratory results for 136 simulated patients was created using information derived from actual patient encounters.The patient database was used to perform a virtual, live exercise using a training version of the emergency department's information system software.Results:Several solutions to increase patient flow were demonstrated during the exercise. Conducting the exercise helped identify several faults in the hospital disaster plan, including outlining the important rate-limiting step. In addition, a significant degree of under-triage was demonstrated. Estimates of multiple markers of patient flow were identified and compared to Canadian guidelines. Most participants reported that the exercise was a valuable learning experience.Conclusions:A virtual, live exercise using the disastermed.ca patient database was an inexpensive method to evaluate the emergency department disaster plan. This included discovery of new approaches to managing patients, delineating the rate-limiting steps, and evaluating triage accuracy. Use of the patient timestamps has potential as a standardized international benchmark of hospital disaster plan efficacy. Participant satisfaction was high.

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

2008 ◽  
Vol 23 (4) ◽  
pp. 354-360 ◽  
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.

Sign in / Sign up

Export Citation Format

Share Document