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Throughput triage Left without being seen

Miquel Sánchez, Montse Suárez, María Asenjo, Ernest Bragulat
Objective: To apply lean thinking in triage acuity level-3 patients in order to improve emergency department (ED) throughtput and waiting time. Design: A prospective interventional study. Setting: An ED of a tertiary care hospital. Participants: Triage acuity level-3 patients. Intervention(s): To apply lean techniques such as value stream mapping, workplace organization, reduction of wastes and standardization by the frontline staff...
May 1, 2018: International Journal for Quality in Health Care
Ryan M Gardner, Nathan A Friedman, Michael Carlson, Tamala S Bradham, Tyler W Barrett
BACKGROUND: Emergency department (ED) crowding is associated with patient safety concerns, increased patients left without being seen (LWBS), low patient satisfaction, and lost ED revenue. The objective was to measure the impact of a revised triage process on ED throughput. METHODS: This study took place at an urban, university-affiliated, adult ED with an annual census of 70,000 and admission rate of 34%. The revised triage approach included: identifying eligible patients at triage based on complaint, comorbidities, and illness acuity; and reallocating a nurse practitioner (NP) into our triage area...
January 2018: American Journal of Emergency Medicine
Chung-Hsien Chaou, Hsiu-Hsi Chen, Shu-Hui Chang, Petrus Tang, Shin-Liang Pan, Amy Ming-Fang Yen, Te-Fa Chiu
BACKGROUND: Emergency department (ED) crowding continues to be an important health care issue in modern countries. Among the many crucial quality indicators for monitoring the throughput process, a patient's length of stay (LOS) is considered the most important one since it is both the cause and the result of ED crowding. The aim of this study is to identify and quantify the influence of different patient-related or diagnostic activities-related factors on the ED LOS of discharged patients...
2017: PloS One
Andrew Gray, Christopher M B Fernandes, Kristine Van Aarsen, Melanie Columbus
OBJECTIVES: Computerized 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). METHODS: We 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...
July 2016: CJEM
Julie Copeland, Andrew Gray
OBJECTIVES: Fast tracks are one approach to reduce emergency department (ED) crowding. No studies have assessed the use of fast tracks in smaller hospitals with single physician coverage. Our study objective was to determine if implementation of an ED fast track in a single physician coverage setting would improve wait times for low-acuity patients without negatively impacting those of higher acuity. METHODS: A daytime fast track opened in 2010 at Strathroy Middlesex General Hospital, a southwestern Ontario community hospital...
November 2015: CJEM
Stephen J Traub, Joseph P Wood, James Kelley, David M Nestler, Yu-Hui Chang, Soroush Saghafian, Christopher A Lipinski
BACKGROUND: Although the use of a physician and nurse team at triage has been shown to improve emergency department (ED) throughput, the mechanism(s) by which these improvements occur is less clear. OBJECTIVES: 1) To describe the effect of a Rapid Medical Assessment (RMA) team on ED length of stay (LOS) and rate of left without being seen (LWBS); 2) To estimate the effect of RMA on different groups of patients. METHODS: For Objective 1, we compared LOS and LWBS on dates when we utilized RMA to comparable dates when we did not...
May 2015: Journal of Emergency Medicine
David M Nestler, Michael P Halasy, Alesia R Fratzke, Christopher J Church, Lori N Scanlan-Hanson, Christine M Lohse, Ronna L Campbell, Annie T Sadosty, Erik P Hess
OBJECTIVES: Patient throughput is an increasingly important cause of emergency department (ED) crowding. The authors previously reported shorter patient length of stay (LOS) when adding a triage liaison provider, which required additional personnel. Here, the objective was to evaluate the effect of moving a fast-track provider to the triage liaison role. METHODS: This was a prospective observational before-and-after study design with predefined outcomes measures...
July 2014: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Antonia Schirmer Stang, Jane McCusker, Antonio Ciampi, Erin Strumpf
OBJECTIVES: As emergency department (ED) waiting times and volumes increase, substantial numbers of patients leave without being seen (LWBS) by a physician. The objective of this study was to identify ED conditions reflecting patient input, throughput, and output associated with the number of patients who LWBS in a pediatric setting. METHODS: This study was a retrospective, descriptive study using data from 1 urban, tertiary care pediatric ED. The study population consisted of all patient visits to the ED from April 2005 to March 2007...
October 2013: Pediatric Emergency Care
Jason Imperato, Darren Scott Morris, David Binder, Christopher Fischer, John Patrick, Leon Dahomey Sanchez, Gary Setnik
To determine if a physician in triage (PIT) improves Emergency Department (ED) patient flow in a community teaching hospital. This is an interventional study comparing patient flow parameters for the 3-month periods before and after implementation of a PIT model. During the interventional time an additional attending physician was assigned to triage from 1 p.m. to 9 p.m. daily. Outcome measures were median time to attending physician evaluation, median length of stay (LOS), number of patients who left without being seen (LWBS), and total time and number of days on ambulance diversion...
October 2012: Internal and Emergency Medicine
Lauren Staggs, Meagan Peek, Gary Southard, Ed Gracely, Sidney Baxendale, Keith P Cross, In K Kim
OBJECTIVE: Asthma is one of the most common childhood illnesses and accounts for a substantial amount of pediatric emergency department visits. Historically, acute exacerbations are treated with a beta agonist via nebulizer therapy (NEB). However, with the advent of the spacer, the medication can be delivered via a metered dose inhaler (MDI+S) with the same efficacy for mild-to-moderate asthma exacerbations. To date, no study has been done to evaluate emergency department (ED) length of stay (LOS) and opportunity cost between nebulized vs MDI+S...
2012: Journal of Medical Economics
Stacy L Doyle, Jennifer Kingsnorth, Cathie E Guzzetta, Sara A Jahnke, Johanna C McKenna, Kathleen Brown
INTRODUCTION: Efficiency and effectiveness are often used as quality indicators in emergency departments. With an aim to improve patient throughput and departmental efficiency while decreasing left-without-being-seen (LWBS) rates, this two-group, pre-intervention, post-intervention study in a pediatric emergency department evaluated the outcomes of implementing rapid triage on arrival-to-triage time, fast track utilization, and LWBS. METHODS: We implemented rapid triage assessment integrating the Emergency Severity Index and fast track guidelines in our pediatric emergency department...
January 2012: Journal of Emergency Nursing: JEN: Official Publication of the Emergency Department Nurses Association
James Graham, Mary E Aitken, Steve Shirm
OBJECTIVE: Emergency department (ED) crowding is an increasingly common problem in the United States. Crowding can lead to ED closure and diversion, poor patient satisfaction, and patient safety issues. The purpose of this study was to examine measures of ED census and measures of crowding to determine if a correlation exists in a pediatric ED setting. METHODS: Arkansas Children's Hospital is a major pediatric referral center. Measures of ED acuity (including total census, admission rate, total number of admissions, and proportion of triage category nonurgent patients) and measures of throughput (left-without-being-seen [LWBS] rate and ED length of stay [LOS]) data for 11 years (1996-2006) were plotted, and correlation coefficients were calculated...
August 2011: Pediatric Emergency Care
(no author information available yet)
The leaders at King's Daughters Medical Center in Ashland, KY, firmly believe that solving ED throughput problems must be the responsibility of the entire hospital. They must be on the right track. A recent initiative has slashed the rate of patients who left without being seen from 5% to 0.5%. When beds are available in the ED, presenting patients are moved there immediately and then triaged by the bed nurse. Throughput assessments are conducted hourly so that problems can be addressed immediately. When the ED is in danger of becoming overwhelmed, all department leaders are paged and direct their units to take appropriate action...
April 2010: ED Management: the Monthly Update on Emergency Department Management
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