Search

Emergency Department (ED) overcrowding and ensuing concern about patients who leave without treatment have become a mounting national concern. In addition, the Centers for Medicaid and Medicare Services released regulatory standards for EDs requiring reporting of time from initial triage to decision to admit, as well as actual time of admission.To implement an improved ED patient flow process.We performed a comparative, pre- and post-intervention ED redesign study evaluating three primary end points between two similar, seasonal time periods.Despite an 11% increase in daily patient volume in 2010, analysis of time to provider pre-ED redesign and post-ED redesign implementation revealed a mean of 126.7 min in 2009 (SD 37.03) vs. a mean of 26.3 min in 2010 (SD 1.17). The p-value was significant at0.001. Overall ED average length of stay (ALOS) in 2009 was 5.5 h (SD 0.68) and 3.6 h (SD 1.16) in 2010, reflecting a mean reduction in ALOS of 1.9 h. The p-value was significant at0.01. The proportion of patients who left without treatment (LWOT) also decreased. The proportion of LWOTs during the 2009 study period was 8.7% (95% confidence interval [CI] 6.14-11.26%), compared to 0.2% (95% CI 0.14-0.36%; p0.005) in the 2010 study period. Although the overall ED-visit Press Ganey patient-satisfaction scores improved during the 2010 study period, the results were not statistically significant (p0.1).Our study demonstrated that a tailored ED redesign process can dramatically decrease the time to provider, ALOS, and LWOT rates.

Freestanding emergency departments (FEDs) have become increasingly popular as the need for emergency care continues to grow.To analyze the impact of two FEDs on a local tertiary care center's patient volume and admission rates.A retrospective analysis examined monthly volume and admission rates for the main ED and two FEDs located 9.6 and 12 miles away. Main ED census records were divided into three distinct time frames: period A (control) was January 2007 through June 2007. Period B was July 2007 through July 2009 when one FED was open. Period C was August 2009 through June 2010 when both FEDs were open. A two-factor analysis of variance was used to analyze admission rates while adjusting for monthly variation.The mean monthly patient volume for the main ED was 4709 for period A, but dropped significantly (p0.01) to 4447 for period B, and again dropped significantly (p0.01) to 4242 during period C. The volume for all facilities increased throughout the study period. A combined monthly volume increase to 5642 occurred in Period B, and increased to 6808 in Period C. The adjusted mean admission rate at the main ED for period A was 0.221, which dropped somewhat, though not significantly (p=0.3505) to 0.213 for period B, and then significantly (p0.01) to 0.189 for period C.Opening two FEDs decreased the volume and admission rates for the main ED and increased the overall ED volume for the health care system.

Background: The increasing presence of electronic health records (EHRs) in health care presents interesting and unique challenges in the Emergency Department (ED) setting. Unfortunately, scant literature exists addressing the implementation of EHRs in this setting. Objectives: The authors, both involved in the implementation of such systems at their respective institutions, review the challenges and benefits that exist with such implementation, and the steps that EDs can take to facilitate this process. Discussion: Unlike ambulatory and inpatient settings, where patient volume can be adjusted to help with this transition, EDs are unable to alter their volume and must maximize their efficiency during this process. Conclusions: Understanding and anticipating the EHR's impact on workflow is critical to successful implementation.

Although the issues concerning the impact of emergency department (ED) overcrowding have been the subject of much recent concern, there are few data regarding the effect of ED census on emergency physician behavior with respect to the decision to admit patients. Admission rates might either increase or decrease on busy days, when the system and the physician are under stress.The purpose of this study was to determine if ED physicians change their admitting behavior depending on ED census.This was a retrospective review of 3 months' data (92 consecutive days, July 9-October 9, 2006) in a community ED with an annual census of approximately 70,000 patients and an emergency medicine residency program. We defined each of the 92 days to be either "busy" (180 patients seen), "slow" (147 patients seen) or "medium" (147-180 patients seen). We then compared the rates of admission to the hospital on the "busy," "medium," and "slow" days. We also compared each attending physician's personal rates of admission on slow days to his or her rate of admission on medium or busy days. ED staffing was constant throughout the study period. All comparisons were with chi-squared.There were 14,969 patients seen in the ED during the 92 study days. On "busy" days, 20.1% of the 3400 patients were admitted to the hospital; on "medium" days, 20.6% of the 9057 patients were admitted; on "slow" days, 19.7% of the 2512 patients were admitted. There was no significant association between the level of patient volume in the ED and rate of admission (p = 0.55). When comparing each of 14 attending physicians to him- or herself, there was no significant association found between rate of admission and ED census (all p values0.3). All three categories of days, "busy," "medium," and "slow" did not differ in terms of acuity as judged by triage level distribution.The likelihood of a patient's admission vs. discharge is not affected by ED patient volume. Furthermore, we found no evidence that an individual physician's admitting behavior was associated with ED patient volume.

This study was conducted to explain a more than threefold increase in anticipated patient visits associated with the opening of a separate pediatric emergency department (PED) 2 miles from the nearest general emergency department. Population demographics and data pertaining to visits to other emergency departments were obtained. Parents visiting the new PED were surveyed using a standardized questionnaire. Over the study period (1984–1989), the city population increased by 7%; school population increased by 17%, with no increase in birth rate. Total patient visits to the other city hospitals increased by less than 10%, while the number of visits to the PED increased 250% over anticipated visits. Of children visiting the PED, 48% were less than 5 years old, 30% had lived at their current address less than 2 years, and 80% came from the geographic area close to the PED. Parental decision to bring the child to the PED was as follows: a service perceived to be “for kids” (47%), previous visit (42%), closest facility (33%), better service (20%), referred (12%), and pediatrician availability (10%). The PED is staffed by licensed pediatricians, whereas the general emergency departments are staffed by emergency physicians. We conclude that the increase in visits cannot be accounted for by increases in regional population base only. Anticipated patient volume to a new health care facility should not be based on population demographics only, but on other factors such as user perception of facility. Patient or parent preference should also be considered.