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Emergency department throughput

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https://www.readbyqxmd.com/read/27856140/impact-of-scribes-on-emergency-department-patient-throughput-one-year-after-implementation
#1
Heather A Heaton, David M Nestler, Christine M Lohse, Annie T Sadosty
OBJECTIVES: Assess the impact of scribes on an academic emergency department's (ED) throughput one year after implementation. METHODS: A prospective cohort design compared throughput metrics of patients managed when scribes were and were not a part of the treatment team during pre-defined study hours in a tertiary academic ED with both an adult and pediatric ED. An alternating-day pattern one year following scribe implementation ensured balance between the scribe and non-scribe groups in time of day, day of week, and patient complexity...
November 5, 2016: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27818014/utilizing-six-sigma-lean-strategies-to-expedite-emergency-department-ct-scan-throughput-in-a-tertiary-care-facility
#2
Devon Klein, Vandana Khan
No abstract text is available yet for this article.
November 3, 2016: Journal of the American College of Radiology: JACR
https://www.readbyqxmd.com/read/27791449/lean-intervention-improves-patient-discharge-times-improves-emergency-department-throughput-and-reduces-congestion
#3
Michael J Beck, Davin Okerblom, Anika Kumar, Subhankar Bandyopadhyay, Lisabeth V Scalzi
: (Abstract) Objective: To determine if a lean intervention improved emergency department (ED) throughput and reduced ED boarding by improving patient discharge efficiency from a tertiary care children's hospital. METHODS: The study was conducted at a tertiary care children's hospital to study the impact lean that changes made to an inpatient pediatric service line had on ED efficiency. Discharge times from the general pediatrics' service were compared to patients discharged from all other pediatric subspecialty services...
October 28, 2016: Hospital Practice (Minneapolis)
https://www.readbyqxmd.com/read/27663766/ed-triage-pain-protocol-reduces-time-to-receiving-analgesics-in-patients-with-painful-conditions
#4
Aaron Nathan Barksdale, Jeff Lee Hackman, Karen Williams, Matt Christopher Gratton
BACKGROUND: Studies suggest that collaborative nursing protocols initiated in triage improve emergency department (ED) throughput and decrease time to treatment. OBJECTIVE: The objective of the study is to determine if an ED triage pain protocol improves time to provision of analgesics. METHODS: Retrospective data abstracted via electronic medical record of patients at a safety net facility with 67 000 annual adult visits. Patients older than 18 years who presented to the ED between March 1, 2011, and May 31, 2013, with 1 of 6 conditions were included: back pain, dental pain, extremity trauma, sore throat, ear pain, or pain from an abscess...
August 27, 2016: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27658897/systematic-identification-and-management-of-barriers-to-vascular-surgery-patient-discharge-time-of-day
#5
Gaurav Sharma, Danny Wong, Dean J Arnaoutakis, Samir K Shah, Alice O'Brien, Stanley W Ashley, C Keith Ozaki
OBJECTIVE: Length of stay fails to completely capture the clinical and economic effects of patient progression through the phases of inpatient care, such as admission, room placement, procedures, and discharge. Delayed hospital throughput has been linked to increased time spent in the emergency department and postanesthesia care unit, delayed time to treatment, increased in-hospital mortality, decreased patient satisfaction, and lost hospital revenue. We identified barriers to vascular surgery inpatient care progression and instituted defined measures to positively impact standardized metrics...
September 19, 2016: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/27658706/primary-triage-nurses-do-not-divert-patients-away-from-the-emergency-department-at-times-of-high-in-hospital-bed-occupancy-a-retrospective-cohort-study
#6
Mathias C Blom, Karin Erwander, Lars Gustafsson, Mona Landin-Olsson, Fredrik Jonsson, Kjell Ivarsson
BACKGROUND: Emergency department (ED) overcrowding is frequently described in terms of input- throughput and output. In order to reduce ED input, a concept called primary triage has been introduced in several Swedish EDs. In short, primary triage means that a nurse separately evaluates patients who present in the Emergency Department (ED) and either refers them to primary care or discharges them home, if their complaints are perceived as being of low acuity. The aim of the present study is to elucidate whether high levels of in-hospital bed occupancy are associated with decreased permeability in primary triage...
September 22, 2016: BMC Emergency Medicine
https://www.readbyqxmd.com/read/27605653/emergency-department-length-of-stay-for-psychiatric-visits-was-significantly-longer-than-for-nonpsychiatric-visits-2002-11
#7
Jane M Zhu, Astha Singhal, Renee Y Hsia
Despite increases in the use of emergency department (EDs) for mental health care, there are limited data on whether psychiatric patients disproportionately contribute to ED crowding. We conducted a retrospective analysis using a national database of ED visits in the period 2002-11 to describe trends in median and ninetieth-percentile length-of-stay for patients with psychiatric versus nonpsychiatric primary diagnoses. Psychiatric patients who visited the ED were transferred to another facility at six times the rate of nonpsychiatric patients...
September 1, 2016: Health Affairs
https://www.readbyqxmd.com/read/27603225/effect-of-lean-processes-on-surgical-wait-times-and-efficiency-in-a-tertiary-care-veterans-affairs-medical-center
#8
Nakul P Valsangkar, Andrew C Eppstein, Rick A Lawson, Amber N Taylor
Importance: There are an increasing number of veterans in the United States, and the current delay and wait times prevent Veterans Affairs institutions from fully meeting the needs of current and former service members. Concrete strategies to improve throughput at these facilities have been sparse. Objective: To identify whether lean processes can be used to improve wait times for surgical procedures in Veterans Affairs hospitals. Design, Setting, and Participants: Databases in the Veterans Integrated Service Network 11 Data Warehouse, Veterans Health Administration Support Service Center, and Veterans Information Systems and Technology Architecture/Dynamic Host Configuration Protocol were queried to assess changes in wait times for elective general surgical procedures and clinical volume before, during, and after implementation of lean processes over 3 fiscal years (FYs) at a tertiary care Veterans Affairs medical center...
September 7, 2016: JAMA Surgery
https://www.readbyqxmd.com/read/27564093/dedicated-pediatricians-in-emergency-department-shorter-waiting-times-and-lower-costs
#9
Manuel Rocha Melo, Manuel Ferreira-Magalhães, Filipa Flor-Lima, Mariana Rodrigues, Milton Severo, Luis Almeida-Santos, Alberto Caldas-Afonso, Pedro Pita Barros, António Ferreira
BACKGROUND: Dedicated pediatricians in emergency departments (EDs) may be beneficial, though no previous studies have assessed the related costs and benefits/harms. We aimed to evaluate the net benefits and costs of dedicated emergency pediatricians in a pediatric ED. METHODS: Cost-consequences analysis of visits to a pediatric ED of a tertiary hospital. Two pediatric ED Medical Teams (MT) were compared: MT-A (May-September 2012), with general pediatrics physicians only; and MT-B (May-September 2013), with emergency dedicated pediatricians...
2016: PloS One
https://www.readbyqxmd.com/read/27527398/initiating-diagnostic-studies-on-patients-with-abdominal-pain-in-the-waiting-room-decreases-time-spent-in-an-emergency-department-bed-a%C3%A2-randomized-controlled-trial
#10
Tomer Begaz, David Elashoff, Tristan R Grogan, David Talan, Breena R Taira
STUDY OBJECTIVE: The effect of clinician screening of patients in the emergency department (ED) waiting room is unclear. This study aims to determine the effect of initiating laboratory and imaging studies from the ED waiting room on time in a bed, total ED time, and likelihood of patients leaving before completion of service. METHODS: This was a prospective, randomized, controlled trial evaluating 1,659 nonpregnant adults with a chief complaint of abdominal pain, conducted in a public hospital ED when all ED beds were occupied and patients were in the waiting room awaiting definitive evaluation...
August 12, 2016: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/27524106/efficiency-in-the-emergency-department-a-complex-relationship-between-throughput-rates-and-staff-perceptions
#11
Ulrica von Thiele Schwarz, Henna Hasson, Sa Muntlin Athlin
INTRODUCTION: It is well known that emergency departments (EDs) suffer from crowding and throughput challenges, which make the ED a challenging workplace. However, the interplay between the throughput of patients and how staff experience work is seldom studied. The aim of this study was to investigate whether staff experience of work (efficiency, work-related efforts and rewards, and quantity and quality of work) differs between days with low and high patient throughput rates. METHOD: Throughput times were collected from electronic medical records and staff (n=252 individuals, mainly nurses) ratings in daily questionnaires over a total of six weeks...
August 11, 2016: International Emergency Nursing
https://www.readbyqxmd.com/read/27478347/emergency-department-crowding-disparity-a-nationwide-cross-sectional-study
#12
Won Chul Cha, Ki Ok Ahn, Sang Do Shin, Jeong Ho Park, Jin Sung Cho
In this study, we evaluated national differences in emergency department (ED) crowding to identify factors significantly associated with crowding in institutes and communities across Korea. This was a cross-sectional nationwide observational study using data abstracted from the National Emergency Department Information System (NEDIS). We calculated mean occupancy rates to quantify ED crowding status and divided EDs into three groups according to their occupancy rates (cutoffs: 0.5 and 1.0). Factors potentially related to ED crowding were collected from the NEDIS...
August 2016: Journal of Korean Medical Science
https://www.readbyqxmd.com/read/27450391/impact-of-scribes-on-patient-throughput-in-adult-and-pediatric-academic-eds
#13
Heather A Heaton, David M Nestler, Derick D Jones, Christine M Lohse, Deepi G Goyal, Jeffrey S Kallis, Annie T Sadosty
OBJECTIVES: Assess the impact of scribes on an academic emergency department's (ED) patient-specific throughput. METHODS: Study design, setting, participants: A prospective cohort design compared throughput metrics of patients managed when scribes were and were not a part of the treatment team during pre-defined study hours in a tertiary academic ED with both an adult and pediatric ED. INTERVENTION: Eight scribes were hired and trained on-site by a physician with experience in scribe implementation...
October 2016: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27434938/to-get-it-right-up-front-you-have-to-be-up-front
#14
(no author information available yet)
Emergency department case managers are essential to prevent payer denials by ensuring that patient status and level of care is correct; prevent admissions and readmissions by linking patients to community services; improve patient throughput by ensuring that tests are procedures are conducted in a timely manner; and to facilitate hospice and palliative care referrals. Case managers should cover the ED seven days a week during the hours when the volume is highest. Hospitals with a lot of payers that require preauthorization, or a large volume of complex patients, or those with behavioral disorders may need 24-hour coverage...
July 2016: Hospital Case Management: the Monthly Update on Hospital-based Care Planning and Critical Paths
https://www.readbyqxmd.com/read/27431738/increased-door-to-admission-time-is-associated-with-prolonged-throughput-for-ed-patients-discharged-home
#15
Scott P Krall, Jose Guardiola, Peter B Richman
BACKGROUND: Emergency Department (ED) service evaluations are typically based on surveys of discharged patients. Physicians/administrators benefit from data that quantifies system-based factors that adversely impact the experience of those who represent the survey cohort. OBJECTIVE: While investigators have established that admitted patient boarding impacts overall ED throughput times, we sought to specifically quantify the relationship between throughput times for patients admitted (EDLOS) versus discharged home from the ED (DCLOS)...
September 2016: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27379909/medical-observation-units-and-emergency-department-collaboration-improving-patient-throughput
#16
Danielle Gabele, Charlene Bugais, Joanne Laguna
OBJECTIVE: The aim of this study was to identify whether observation status patients placed in a dedicated unit would decompress the emergency department (ED) more than observation patients who were admitted to other available beds. BACKGROUND: An urban quaternary hospital has a high volume of patients with average daily census of 95% capacity. A medical observation unit (MOU) was created to improve patient throughput. METHODS: In phase 1, the MOU charge nurse reviewed the ED patients to be admitted and selected appropriate patients based on unit inclusion criteria...
July 2016: Journal of Nursing Administration
https://www.readbyqxmd.com/read/27279469/edtitrate-emergency-department-telemedicine-initiative-to-rapidly-accommodate-in-times-of-emergency
#17
Vaishal Tolia, Eddie Castillo, David Guss
OBJECTIVE: Emergency Department (ED) patient volumes are unpredictable, which can result in service delays and patients leaving without care. We initiated a programme of emergency physician (EP) telepresence in the ED with the objectives of assessing feasibility, safety, patient and provider acceptance, and throughput time. METHODS: This was a prospective convenience study. Patients presenting to the ED during operation of the study who were planned for placement in the waiting room were considered for enrolment...
June 8, 2016: Journal of Telemedicine and Telecare
https://www.readbyqxmd.com/read/27135731/discharge-rounds-implementation-of-a-targeted-intervention-for-improving-patient-throughput-on-an-inpatient-medical-teaching-service
#18
Krisda H Chaiyachati, Andre N Sofair, Jeremy I Schwartz, David Chia
OBJECTIVES: Patient throughput and early discharges are important for decreasing emergency department wait times and creating available beds for new hospital admissions. The educational schedule of internal medicine trainees can interfere with timely discharges, but targeted interventions can help residents meet the hospital's patient flow needs. Our training program instituted daily morning discharge rounds on the inpatient service, requiring each team to prepare potential discharges 1 day ahead and prioritizing these discharges the next day...
May 2016: Southern Medical Journal
https://www.readbyqxmd.com/read/27130191/are-split-flow-and-provider-in-triage-models-in-the-emergency-department-effective-in-reducing-discharge-length-of-stay
#19
Beth A Pierce, Denise Gormley
A quality improvement (QI) project was completed early in 2015 to evaluate the split flow model of care delivery and a provider in triage model within a newly constructed emergency department. The QI project compared 2 emergency departments of similar volumes, one that splits the patient flow and employs a provider in triage model and the other that blends the patient flow and employs a traditional nurse triage model. A total of 68,603 patients were included in this project. The purpose of the split flow model is to create a second flow stream of patients through the emergency department, parallel to the regular acute/critical care flow stream, for patients with problems that are not complex...
November 2016: Journal of Emergency Nursing: JEN: Official Publication of the Emergency Department Nurses Association
https://www.readbyqxmd.com/read/27018711/the-impact-of-computerized-provider-order-entry-on-emergency-department-flow
#20
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
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