The impact of a multimodal intervention on emergency department crowding and patient flow

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.

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The impact of medical specialist staffing on emergency department patient flow and satisfaction

European Journal of Emergency Medicine ◽

10.1097/mej.0000000000000487 ◽

2019 ◽

Vol 26 (1) ◽

pp. 47-52 ◽

Cited By ~ 5

Author(s):

M. Christien van der Linden ◽

Roeline A.Y. de Beaufort ◽

Sven A.G. Meylaerts ◽

Crispijn L. van den Brand ◽

Naomi van der Linden

Keyword(s):

Emergency Department ◽

Patient Flow ◽

Emergency Department Patient ◽

Medical Specialist ◽

The Impact

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Inhaled methoxyflurane for the reduction of acute anterior shoulder dislocation in the emergency department

CJEM ◽

10.1017/cem.2018.493 ◽

2019 ◽

Vol 21 (4) ◽

pp. 468-472 ◽

Cited By ~ 3

Author(s):

Etimbuk Umana ◽

Josephine Hannah Kelliher ◽

Christiaan Johannes Blom ◽

Brian McNicholl

Keyword(s):

Emergency Department ◽

Shoulder Dislocation ◽

Recovery Time ◽

Patient Flow ◽

Hospital Setting ◽

Anterior Shoulder Dislocation ◽

Fracture Dislocations ◽

Record Review ◽

The Impact ◽

Successful Reduction

ABSTRACTObjectivesMethoxyflurane is an inhalation analgesic used in the emergency department (ED) but also has minimal sedative properties. The major aim of this study was to evaluate the success rate of methoxyflurane for acute anterior shoulder dislocation (ASD) reduction. The secondary aim was to assess the impact of methoxyflurane on ED patient flow compared to propofol.MethodsA health record review was performed for all patients presenting with ASD who underwent reduction with either methoxyflurane or propofol over a 13-month period (December 2016 – December 2017). The primary outcome was reduction success for methoxyflurane, while secondary outcomes such as recovery time and ED length of stay (LOS) were also assessed compared to propofol. Patients with fracture dislocations, polytrauma, intravenous, or intramuscular opioids in the pre-hospital setting, no sedation for reduction, and alternative techniques of sedation or analgesia for reduction were excluded.ResultsA total of 151 patients presented with ASD during the study period. Eighty-two patients fulfilled our inclusion criteria. Fifty-two patients had ASD reduction with propofol while 30 patients had methoxyflurane. Successful reduction was achieved in 80% (95% CI 65.69% to 94.31%) patients who used methoxyflurane. The median recovery time and ED LOS were 30 minutes [19.3-44] and 70.5 minutes [49.3-105], which was found to be shorter for the methoxyflurane group, who had successful reductions compared to sedation with propofol.ConclusionMethoxyflurane was used successfully in 30% of the 82 patients undergoing reduction for ASD, while potentially improving ED efficiency.

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Evaluating the impact of emergency department crowding on disposition patterns and outcomes of discharged patients

International Journal of Emergency Medicine ◽

10.1186/s12245-019-0223-1 ◽

2019 ◽

Vol 12 (1) ◽

Cited By ~ 2

Author(s):

Mahshid Abir ◽

Jason E. Goldstick ◽

Rosalie Malsberger ◽

Andrew Williams ◽

Sebastian Bauhoff ◽

...

Keyword(s):

Emergency Department ◽

Emergency Department Crowding ◽

Discharged Patients ◽

The Impact

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Type of facility influences lengths of stay of children presenting to high volume emergency departments

BMC Pediatrics ◽

10.1186/s12887-020-02400-6 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Rhonda J. Rosychuk ◽

Brian H. Rowe

Keyword(s):

Emergency Department ◽

Length Of Stay ◽

Emergency Departments ◽

High Volume ◽

Population Based ◽

Initial Assessment ◽

Teaching Hospitals ◽

Emergency Department Crowding ◽

Academic Teaching ◽

The Impact

Abstract Background Emergency department crowding may impact patient and provider outcomes. We describe emergency department crowding metrics based on presentations by children to different categories of high volume emergency departments in Alberta, Canada. Methods This population-based retrospective study extracted all presentations made by children (age < 18 years) during April 2010 to March 2015 to 15 high volume emergency departments: five regional, eight urban, and two academic/teaching. Time to physician initial assessment, and length of stay for discharges and admissions were calculated based on the start of presentation and emergency department facility. Multiple metrics, including the medians for hourly, facility-specific time to physician initial assessment and length of stay were obtained. Results About half (51.2%) of the 1,124,119 presentations were made to the two academic/teaching emergency departments. Males presented more than females (53.6% vs 46.4%) and the median age was 5 years. Pediatric presentations to the three categories of emergency departments had mostly similar characteristics; however, urban and academic/teaching emergency departments had more severe triage scores and academic/teaching emergency departments had higher admissions. Across all emergency departments, the medians of the metrics for time to physician initial assessment, length of stay for discharges and for admission were 1h11min, 2h21min, and 6h29min, respectively. Generally, regional hospitals had shorter times than urban and academic/teaching hospitals. Conclusions Pediatric presentations to high volume emergency departments in this province suggest similar delays to see providers; however, length of stay for discharges and admissions were shorter in regional emergency departments. Crowding is more common in urban and especially academic emergency departments and the impact of crowding on patient outcomes requires further study.

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The impact of computerized provider order entry on emergency department flow

CJEM ◽

10.1017/cem.2016.11 ◽

2016 ◽

Vol 18 (4) ◽

pp. 264-269 ◽

Cited By ~ 4

Author(s):

Andrew Gray ◽

Christopher M.B. Fernandes ◽

Kristine Van Aarsen ◽

Melanie Columbus

Keyword(s):

Emergency Department ◽

Patient Safety ◽

Improve Patient Safety ◽

Patient Flow ◽

Wait Time ◽

Order Entry ◽

Computerized Provider Order Entry ◽

Left Without Being Seen ◽

Before And After ◽

The Impact

AbstractObjectivesComputerized provider order entry (CPOE) has been established as a method to improve patient safety by avoiding medication errors; however, its effect on emergency department (ED) flow remains undefined. We examined the impact of CPOE implementation on three measures of ED throughput: wait time (WT), length of stay (LOS), and the proportion of patients that left without being seen (LWBS).MethodsWe conducted a retrospective cohort study of all ED patients of 18 years and older presenting to London Health Sciences Centre during July and August 2013 and 2014, before and after implementation of a CPOE system. The three primary variables were compared between time periods. Subgroup analyses were also conducted within each Canadian Triage and Acuity Scale (CTAS) level (1–5) individually, as well as for admitted patients only.ResultsA significant increase in WT of 5 minutes (p=0.036) and LOS of 10 minutes (p=0.001), and an increase in LWBS from 7.2% to 8.1% (p=0.002) was seen after CPOE implementation. Admitted patients’ LOS increased by 63 minutes (p<0.001), the WT of CTAS 3 and 5 patients increased by 6 minutes (p=0.001) and 39 minutes (p=0.005), and LWBS proportion increased significantly for CTAS 3–5 patients, from 24.3% to 42.0% (p<0.001) for CTAS 5 patients specifically.ConclusionsCPOE implementation detrimentally impacted all patient flow throughput measures that we examined. The most striking clinically relevant result was the increase in LOS of 63 minutes for admitted patients. This raises the question as to whether the potential detrimental effects to patient safety of CPOE implementation outweigh its benefits.

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