The effect of a zero-diversion policy on emergency department performance measures

This study examines how emergency department (ED) performance measures at an academic tertiary care center in the Midwest were affected by a regionally-adopted zero diversion policy. Two six-month periods before and after the policy was enacted were selected to measure differences in key performance measures, including left without treatment (LWOT), left without being seen (LWBS), left against medical advice (AMA), mortality, length of stay and hospital admission rate. Total ED census during the two periods was similar. While the zero diversion policy was in effect, LWOT and LWBS rates were 19.4% and 18.2% lower, respectively, than the prior period, p < .002; discharged patients had faster treatment times (228 + 8.0 minutes vs. 242 + 9.0 minutes), p = .015. No differences were observed in AMA or mortality rates. This study revealed no worsening of ED performance measures after adoption of a zero diversion policy.

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An Assessment of Emergency Department Throughput and Provider Satisfaction after the Implementation of a Scribe Program

Advances in Emergency Medicine ◽

10.1155/2014/517319 ◽

2014 ◽

Vol 2014 ◽

pp. 1-7 ◽

Cited By ~ 20

Author(s):

Brandon Allen ◽

Ben Banapoor ◽

Emily C. Weeks ◽

Thomas Payton

Keyword(s):

Emergency Department ◽

Program Implementation ◽

Tertiary Care ◽

Care Facility ◽

Workplace Satisfaction ◽

Electronic Survey ◽

Left Without Being Seen ◽

Tertiary Care Facility ◽

Discharged Patients ◽

The Impact

Objectives. To assess the impact of a scribe program on an academic, tertiary care facility. Methods. A retrospective analysis of emergency department (ED) data, prior to and after scribe program implementation, was used to quantitatively assess the impact of the scribe program on measures of ED throughput. An electronic survey was distributed to all emergency medicine residents and advanced practice providers to qualitatively assess the impact of the scribe program on providers. Results. Several throughput time measures were significantly lower in the postscribe group, compared to prescribe implementation, including time to disposition. The left without being seen (LWBS) decrease was not statistically significant. A total of 30 providers responded to the survey. 100% of providers indicated scribes are a valuable addition to the department and they enjoy working with scribes. 90% of providers indicated scribes increase their workplace satisfaction and quality of life. Conclusions. Through evaluation of prescribe and postscribe implementation, the postscribe time period reflects many throughput improvements not present before scribes began. Scribe Program implementation led to improved ED throughput for discharged patients with further system-wide challenges needing to be addressed for admitted patients.

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LO67: A variation on Triage Liaison Physicians (TLP): a comparative analysis of the Emergency Department Disposition and Care Consultant (EDC) concept

CJEM ◽

10.1017/cem.2018.129 ◽

2018 ◽

Vol 20 (S1) ◽

pp. S30-S30

Author(s):

B. H. Rowe ◽

A. Haponiuk ◽

J. Lowes ◽

W. Sevcik ◽

C. Villa-Roel ◽

...

Keyword(s):

Emergency Department ◽

Tertiary Care ◽

Pilot Project ◽

Chi Square ◽

Left Without Being Seen ◽

Ed Overcrowding ◽

Discharged Patients ◽

Level 3 ◽

Dichotomous Outcomes ◽

And Control

Introduction: Despite evidence that triage liaison physicians (TLP) effectively reduce emergency department (ED) overcrowding, support for these interventions is patchy. The aim of this study was to evaluate the implementation of a TLP-like ED Disposition and Care Consultant (EDC) shift at an academic tertiary care ED. Methods: A 24-week pilot project was conducted 11/16-04/17. Physicians worked 8- hour day (07-15:00) and/or evening (15:00-23:00) EDC shifts and performed immediate triage and patient care when needed, assisted triage RNs, answered all incoming calls, and managed administrative matters. Due to their voluntary nature, not all shifts were filled. This study compared active (EDC) and control (C) shifts on the following ED metrics: length of stay (LOS), proportions of patients who left without being seen (LWBS), and safety (return visits to ED). Descriptive (median and interquartile range {IQR} and proportions) and simple (Wilcoxson-Mann-Whitney, chi-square, z-proportion) tests are presented for continuous and dichotomous outcomes, respectively. Multiple linear regression identified factors associated with LOS. Results: Of 112 possible EDC shifts, 58 (52%) were filled involving 4289 patients and compared to 276 C shifts involving 21,358 patients. ED volume, patient age (49; IQR: 31, 66), mode of arrival (~30% EMS), triage levels (~51% level 3), and complaints were similar between the groups. Overall, the EDC group reduced LWBS by 16% (8.7% vs. 10.4%; p=0.001), ED LOS for discharged patients by 30 minutes (5.5 vs. 6.0 hours; p<0.001), and ED LOS for admitted patients by 42 minutes (9.7 vs. 10.4 hours; p=0.02). The EDC increased the proportion discharged <4 hours by 28% (20.1 vs. 15.7%; p<0.001) and increased the proportion admitted <8 hours by 17% (8.2% vs. 9.6%, p=0.002). ED relapses <72 hours were similar (9.3% vs. 8.9%; p=0.4); however, admissions were higher in the EDC shifts (25.3% vs. 23.8%; p=0.04). In addition to EDC coverage status, LOS was influenced by triage level (1.7%, p<0.001), disposition (19.6%, p<0.001), and age (4.8%, p<0.001). Conclusion: Our results indicate that an EDC shift, while unpopular with many physicians, provides valuable services to an overcrowded ED and that the implementation of this type of shift could reduce LOS and LWBS statistics in a tertiary care institution. Additional evaluations to examine this and other front-end interventions in other ED centers are indicated.

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Management of Acute Asthmatic Attacks in a Local Emergency Department before and after the Introduction of Guidelines

Hong Kong Journal of Emergency Medicine ◽

10.1177/102490790200900303 ◽

2002 ◽

Vol 9 (3) ◽

pp. 131-138

Author(s):

Sh Tsui ◽

Ask Sham ◽

M Chan-Yeung ◽

Hk Tong

Keyword(s):

Emergency Department ◽

Discharge Planning ◽

Acute Asthma ◽

Objective Assessment ◽

Asthma Management ◽

Admission Rate ◽

Asthma Severity ◽

Age Group ◽

Hospital Admission Rate ◽

Before And After

Introduction Objective assessment and management of acute asthma is often sub-optimal in busy emergency departments. This study examined the effect of the introduction of guidelines on asthma management in the emergency department. Materials & Methods All patients (>2 years old) presented to the emergency department for acute asthmatic attacks over a period of 1 year were included. Guidelines for the management of acute asthma were introduced after the first quarter of the study year. Analysis was made to compare the assessment, treatment and discharge planning of patients presenting with acute asthma to the emergency department before and after the introduction of the guidelines. Results After the introduction of the guidelines, there was a significant increase in the measurement of peak expiratory flow rate (PEF) and oxygen saturation as part of patient assessment for asthma severity. Such an improvement did not result in a change in hospital admission rate. There was a significant increase in the proportion of patients discharged with a course of oral corticosteroids, a significant reduction in the use of oral bronchodilators in the younger age group and antibiotics in the older age group. Conclusions The introduction of guidelines for the management of acute asthma and education of the clinicians in the emergency department has resulted in improvement in the overall management and discharge planning for asthma patients.

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Geriatric Visits to the Emergency Department at an Academic Tertiary Care Center in Jeddah, Saudi Arabia

Saudi Journal of Internal Medicine ◽

10.32790/sjim.2017.7.2.4 ◽

2017 ◽

Vol 7 (2) ◽

pp. 21-26

Author(s):

Jameel T. Abualenain ◽

Daniah M. Kamfar ◽

Ekram S. Faden ◽

Mohammed A. Basheikh

Keyword(s):

Emergency Department ◽

Saudi Arabia ◽

Geriatric Patients ◽

Care Center ◽

Tertiary Care ◽

Circulatory System ◽

Admission Rate ◽

Retrospective Chart Review ◽

Emergency Department Visits ◽

University Hospital

Objectives: Geriatric patients aged more than 60 years are a vulnerable group of patients needing special care in the emergency department. This study aims to determine the prevalence of geriatric patients visiting the emergency department and explore the various aspects of those visits. Methods: A retrospective chart review of all emergency department visits from August 2016 to July 2017 was performed at King Abdulaziz University Hospital in Jeddah, Saudi Arabia. Results: Of 34,127 emergency department visits by adults, 6,533 (19.14%) were made by geriatric patients (age range, 60-115 years; average, 71.25 years), representing about 45 nationalities (48.62% were Saudi). Triage priority using the “Canadian Triage and Acuity Scale” showed that 36.08% of the visits were emergencies, 49.35% were urgent, and 14.57% were non-urgent. Most (40.47%) of the visits were made during the morning, almost double the number made at night (23.30%). Geriatric patients presenting with a single complaint represented 62.47% of these visits, those presenting with two complaints represented 31.01%, and those presenting three or more complaints, 6.52%. The most common complaints were dyspnea (25.28%), chest pain (13.16%), and abdominal pain (10.82%). In the final diagnoses, diseases of circulatory system were most frequent (15.20%). The admission rate was 28.38%, and the mortality rate was 1.94%. Conclusion: Geriatric patients visiting the emergency department represent one-fi ft h of all emergency department visits by adults. They commonly present with complex medical conditions, making the approach to their diagnoses more challenging. Therefore, we recommend paying greater attention using multidisciplinary services and follow up.

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Implementation of the acutely presenting older patient (APOP) screening program in routine emergency department care

Zeitschrift für Gerontologie und Geriatrie ◽

10.1007/s00391-020-01837-9 ◽

2021 ◽

Author(s):

Laura C. Blomaard ◽

Bas de Groot ◽

Jacinta A. Lucke ◽

Jelle de Gelder ◽

Anja M. Booijen ◽

...

Keyword(s):

Emergency Department ◽

High Risk ◽

Older Patients ◽

Screening Program ◽

Admission Rate ◽

Older Patient ◽

Hospital Admission Rate ◽

High Risk Patients ◽

Risk Patients

Abstract Objective The aim of this study was to evaluate the effects of implementation of the acutely presenting older patient (APOP) screening program for older patients in routine emergency department (ED) care shortly after implementation. Methods We conducted an implementation study with before-after design, using the plan-do-study-act (PDSA) model for quality improvement, in the ED of a Dutch academic hospital. All consecutive patients ≥ 70 years during 2 months before and after implementation were included. The APOP program comprises screening for risk of functional decline, mortality and cognitive impairment, targeted interventions for high-risk patients and education of professionals. Outcome measures were compliance with interventions and impact on ED process, length of stay (LOS) and hospital admission rate. Results Two comparable groups of patients (median age 77 years) were included before (n = 920) and after (n = 953) implementation. After implementation 560 (59%) patients were screened of which 190 (34%) were high-risk patients. Some of the program interventions for high-risk patients in the ED were adhered to, some were not. More hospitalized patients received comprehensive geriatric assessment (CGA) after implementation (21% before vs. 31% after; p = 0.002). In 89% of high-risk patients who were discharged to home, telephone follow-up was initiated. Implementation did not influence median ED LOS (202 min before vs. 196 min after; p = 0.152) or hospital admission rate (40% before vs. 39% after; p = 0.410). Conclusion Implementation of the APOP screening program in routine ED care did not negatively impact the ED process and resulted in an increase of CGA and telephone follow-up in older patients. Future studies should investigate whether sustainable changes in management and patient outcomes occur after more PDSA cycles.

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Medical Trainee Continuity of Care Following Emergency Department Consultations in a Pediatric Hospital

Journal of Graduate Medical Education ◽

10.4300/jgme-d-15-00018.1 ◽

2016 ◽

Vol 8 (1) ◽

pp. 33-38 ◽

Cited By ~ 1

Author(s):

Kim Bjorklund ◽

Emily A. Eismann ◽

Roger Cornwall

Keyword(s):

Emergency Department ◽

Continuity Of Care ◽

Broad Spectrum ◽

Medical Records ◽

Care Center ◽

Tertiary Care ◽

Well Being ◽

Tertiary Care Center ◽

Pediatric Hospital ◽

Medical Trainee

ABSTRACT Background The importance of continuity of care in training is widely recognized; however, a broad-spectrum assessment across all specialties has not been performed. Objective We assessed the continuity of care provided by trainees, following patient consultations in the emergency department (ED) across all specialties at a large pediatric tertiary care center. Methods Medical records were reviewed to identify patients seen in consultation by a resident or fellow trainee in the ED over a 1-year period, and to determine if the patient followed up with the same trainee for the same condition during the next 6 months. Results Resident and fellow trainees from 33 specialties participated in 3400 ED consultations. Approximately 50% (1718 of 3400) of the patients seen in consultation by a trainee in the ED followed up with the same specialty within 6 months, but only 4.1% (70 of 1718) followed up with the same trainee for the same condition. Trainee continuity of care ranged from 0% to 21% among specialties, where specialties with resident clinics (14.4%) have a greater continuity of care than specialties without resident clinics (2.7%, P < .001). Continuity of care did not differ between fellows (4.2%) and residents (4.0%, P = .87), but did differ between postgraduate years for residents (P < .001). Conclusions Trainee continuity of care for ED consultations was low across all specialties and levels of training. If continuity of care is important for patient well-being and trainee education, efforts to improve continuity for trainees must be undertaken.

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11: Impact of Triage Physician and Clinical Operation Management Consultant Implementation on Emergency Department Throughput at a Tertiary Care Center

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2009.06.031 ◽

2009 ◽

Vol 54 (3) ◽

pp. S4-S5

Author(s):

A. AlDarrab ◽

K. Abuhaimed ◽

T. Alabdullah ◽

H. Alshabanah ◽

M. Almogbil ◽

...

Keyword(s):

Emergency Department ◽

Care Center ◽

Tertiary Care ◽

Operation Management ◽

Tertiary Care Center ◽

Management Consultant

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Abstract 448: Impact of Novel Healthcare Facility First Responder Training on Resuscitation Task Self-Efficacy Measures

Circulation ◽

10.1161/circ.140.suppl_2.448 ◽

2019 ◽

Vol 140 (Suppl_2) ◽

Author(s):

Les R Becker ◽

Cheryl Camacho ◽

Sheryl J Titus ◽

Janet L Thorne ◽

Munish Goyal

Keyword(s):

Ambulatory Care ◽

Self Efficacy ◽

Repeated Measures ◽

Care Center ◽

Tertiary Care ◽

Sudden Cardiac Arrest ◽

Healthcare Facility ◽

Care Hospital ◽

Ambulatory Care Setting ◽

Before And After

Introduction: When sudden cardiac arrest occurs in non-resuscitation focused care settings, bedside clinicians may not intervene prior to dedicated resuscitation team arrival. As perceived self-efficacy (SE) contributes to cognitive functioning, facilitating effective intervention, we developed and evaluated a mock code training approach, First Five (FF) , to enhance bedside responders’ resuscitation task SE using an entity’s defibrillator and manikin. Self-efficacy is knowing that one can perform actions in principle and envision performing the steps to reach a goal. Hypotheses: Participants’ resuscitation SE will improve after FF training; 2) Inpatient (IP) and Ambulatory Care Center (ACC) providers will differ in their pre-SE and post-SE in response to FF training. Methods: Participants enrolled from ACCs and medical-surgical IP units at a large, urban tertiary care hospital from May 2018 to April 2019 completed a de-identified 10-point Likert-scale SE survey before and after they were trained to perform initial bedside resuscitation tasks (Figure 1 x-axis labels). Matched, complete, pre/post data for 85 in-hospital and 107 ACC participants were analyzed via repeated measures multivariate analysis of variance. Results: Patterns of reported change in the seven resuscitation task SE measures of IP personnel differed significantly from those of ACC personnel [Pillai’s Trace = .222, F(7,184)=7.483, p=.0005, partial η 2 = .222]. In both settings, post-session SE measures increased significantly from pre-session SE measures [Pillai’s Trace = .588, F(7,184)=37.438, p=.0005, partial η 2 = .588]. Moreover, though ACC providers consistently reported lower pre-training SE resuscitation task scores, post-training scores from both settings were comparable (Figure 1). Conclusions: First Five training is effective in enhancing resuscitation task SE among inpatient and ambulatory care setting providers that are not resuscitation-focused.

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Effect of pharmacist-led task force to reduce opioid prescribing in the emergency department

American Journal of Health-System Pharmacy ◽

10.1093/ajhp/zxz204 ◽

2019 ◽

Vol 76 (22) ◽

pp. 1853-1861

Author(s):

Nicole M Acquisto ◽

Rachel F Schult ◽

Sandra Sarnoski-Roberts ◽

Jaclyn Wilmarth ◽

Courtney M C Jones ◽

...

Keyword(s):

Emergency Department ◽

Task Force ◽

Care Center ◽

Linear Regression Analysis ◽

Tertiary Care ◽

Interrupted Time Series Analysis ◽

Opioid Use ◽

Entire Study ◽

Opioid Prescribing ◽

Reduction Program

Abstract Purpose Results of a study to determine the effect of a pharmacist-led opioid task force on emergency department (ED) opioid use and discharge prescriptions are presented. Methods An observational evaluation was conducted at a large tertiary care center (ED volume of 115,000 visits per year) to evaluate selected opioid use outcomes before and after implementation of an ED opioid reduction program by interdisciplinary task force of pharmacists, physicians, and nurses. Volumes of ED opioid orders and discharge prescriptions were evaluated over the entire 25-month study period and during designated 1-month preimplementation and postimplementation periods (January 2017 and January 2018). Opioid order trends were evaluated using linear regression analysis and further investigated with an interrupted time series analysis to determine the immediate and sustained effects of the program. Results From January 2017 to January 2018, ED opioid orders were reduced by 63.5% and discharge prescriptions by 55.8% from preimplementation levels: from 246.8 to 90.1 orders and from 85.3 to 37.7 prescriptions per 1,000 patient visits, respectively. Over the entire study period, there were significant decreases in both opioid orders (β, –78.4; 95% confidence interval [CI], –88.0 to –68.9; R2, 0.93; p < 0.0001) and ED discharge prescriptions (β, –24.4; 95% CI, –27.9 to –20.9; R2, 0.90; p < 0.001). The efforts of the task force had an immediate effect on opioid prescribing practices; results for effect sustainability were mixed. Conclusion A clinical pharmacist–led opioid reduction program in the ED was demonstrated to have positive results, with a more than 50% reduction in both ED opioid orders and discharge prescriptions.

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