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

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.

scholarly journals Home Care Nursing Visits and Same-Day Emergency Department Use: Which Patients Are Most at Risk?

2020 ◽  
pp. 084456212094942
Author(s):  
Connie Schumacher ◽  
Aaron Jones ◽  
Andrew P. Costa
Keyword(s):  
Emergency Department ◽  
Home Care ◽  
Service Use ◽  
Urinary Catheter ◽  
Community Dwelling ◽  
Care Needs ◽  
Home Care Nursing ◽  
Nursing Visit ◽  
Ed Visits ◽  
Care Nursing

Background Home care patients are a growing group of community-dwelling older adults with complex care needs and high health service use. Adult home care patients are at high risk for emergency department (ED) visits, which is greater on the same day as a nursing visit. Purpose The purpose of this study was to examine whether common nursing indicators modified the association between nursing visits and same-day ED visits. Methods A case-crossover design within a retrospective cohort of adult home care patients in Ontario. Results A total of 11,840 home care nursing patients were analyzed. Home care patients who received a home nursing visit were more likely to go the ED afterhours on the same day with a stronger association for visits not admitted to the hospital. Having a urinary catheter increased the risk of a same-day ED visit (OR: 1.78 (95% CI 1.15–1.60) vs. 1.21 (95% CI 1.15–1.28)). No other clinical indicator modified the association. Conclusions The findings of this study can be used to inform care policies and practices for home care nurses in the management of indwelling urinary catheter complications. Further examination of system factors such as capacity and resources available to respond to catheter related complications in the community setting are recommended.

Abstract P220: Disparity In Hospital Admissions And Length Of Stay Based On Income Status For Emergency Department Hypertensive Crisis Visits: A Cross-sectional Study Using The Nationwide Emergency Department Sample

Hypertension ◽  
2021 ◽  
Vol 78 (Suppl_1) ◽  
Author(s):  
Shreya Srivastava ◽  
Bhargav Vemulapalli ◽  
Alexis K Okoh ◽  
John Kassotis
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Regression Model ◽  
Household Income ◽  
Hypertensive Crisis ◽  
Cross Sectional ◽  
Delivery Of Care ◽  
Income Status ◽  
Ed Visits ◽  
Income Quartile

Introduction: Racial, gender and lower socioeconomic status have been shown to negatively impact the delivery of care. How this impacts the management of hypertensive crisis (HC) remains unclear. Objective: Identify disparities on admission frequency and length of stay (LOS) among those presenting with HC, as a function of household income. Methods: This is a cross-sectional analysis of 2016 ED visits and supplemental Inpatient data from the Nationwide Emergency Department Sample. Median household income quartiles were established. A multivariable logistic regression model was used to estimate odds of admission in each income quartile. A multivariable linear regression model was used to predict LOS. Results: After applying sample weighting, the total number of ED visits was 33,728 with 25442, 6906, and 1380 visits for hypertensive urgency (HU), emergency (HE) and unspecified crisis, respectively. There were 13191, 8889, 6401, 5247 visits in the (1 st ) lowest, 2 nd , 3 rd and 4 th (highest) income quartiles, respectively. The median age was 61 and 58 years for HU and HE, respectively. The most common comorbidity was chronic kidney disease. Individuals with the highest income, had a lower odds of admission compared to the lowest quartile [Adjusted Odds Ratio: 0.41, 95% CI: 0.22,0.74] ( Figure 1a ). There was a significant linear association between income quartile and LOS across all HC and HE [beta coefficient: 0.411, 0.407 p value = 0.015, 0.019] ( Figure 1b ). Conclusions: In this study, patients with lower income were more likely to be admitted, while those with higher income exhibited a longer LOS. Clinicians must be made aware these disparities to ensure the equitable delivery of care.

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.

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

2019 ◽  
Vol 26 (1) ◽  
pp. 47-52 ◽  
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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