TY - JOUR
T1 - Emergency department throughput
T2 - an intervention
AU - Haq, Nowreen
AU - Stewart-Corral, Rona
AU - Hamrock, Eric
AU - Perin, Jamie
AU - Khaliq, Waseem
N1 - Funding Information:
Two agency nurses were hired for the intervention study to cover the routine nursing shifts for the inpatient medical unit so that the two ADT trained floor nurses could provide the weekly ADT coverage. Although the intervention was funded by the hospital only for first 12 weeks, in the later part of intervention period, the ADT admission nurse position was maintained by distributing the patients among the existing floor nurses. The charge nurse and ADT nurse worked closely to distribute the patient assignment to the ADT nurse after the first 12 weeks in order to provide the support to floor nurses for early discharges, thus maintaining the 5:1 patient to nursing ratio throughout the intervention period. The ADT nurses were scheduled for 36 h per week for the study intervention from Monday to Saturday.
Publisher Copyright:
© 2018, SIMI.
Copyright:
Copyright 2018 Elsevier B.V., All rights reserved.
PY - 2018/9/1
Y1 - 2018/9/1
N2 - Shortening emergency department (ED) boarding time and managing hospital bed capacity by expediting the inpatient discharge process have been challenging for hospitals nationwide. The objective of this study is was to explore the effect of an innovative prospective intervention on hospital workflow, specifically on early inpatient discharges and the ED boarding time. The intervention consisted of a structured nursing “admission discharge transfer” (ADT) protocol receiving new admissions from the ED and helping out floor nursing with early discharges. ADT intervention was implemented in a 38-bed hospitalist run inpatient unit at an academic hospital. The study population consisted of 4486 patients (including inpatient and observation admissions) who were hospitalized to the medicine unit from March 2013–March 2014. Of these hospitalizations, 2259 patients received the ADT intervention. Patients’ demographics, discharge and ED boarding data were collected for from March 4, 2013 to March 31, 2014 for both intervention and control groups (28 weeks each). Chi-square and unpaired t tests were utilized to compare population characteristics. Poisson regression analysis was conducted to estimate the association between intervention and hospital length of stay adjusted for differences in patient demographics. Mean age of the study population was 58.6 years, 23% were African Americans and 55% were women. A significant reduction in ED boarding time (p < 0.001) and improvement in early (before 2 PM) hospital discharges (p = 0.01) were noticed among patients in the intervention groups. There was a slight but significant reduction in hospital length of stay for observation patients in the intervention group; however, no such difference was noted for inpatient admissions. Our study showed that dedicating nursing resources towards ED-boarded patients and early inpatient discharges can significantly improve hospital workflow and reduce hospital length of stay.
AB - Shortening emergency department (ED) boarding time and managing hospital bed capacity by expediting the inpatient discharge process have been challenging for hospitals nationwide. The objective of this study is was to explore the effect of an innovative prospective intervention on hospital workflow, specifically on early inpatient discharges and the ED boarding time. The intervention consisted of a structured nursing “admission discharge transfer” (ADT) protocol receiving new admissions from the ED and helping out floor nursing with early discharges. ADT intervention was implemented in a 38-bed hospitalist run inpatient unit at an academic hospital. The study population consisted of 4486 patients (including inpatient and observation admissions) who were hospitalized to the medicine unit from March 2013–March 2014. Of these hospitalizations, 2259 patients received the ADT intervention. Patients’ demographics, discharge and ED boarding data were collected for from March 4, 2013 to March 31, 2014 for both intervention and control groups (28 weeks each). Chi-square and unpaired t tests were utilized to compare population characteristics. Poisson regression analysis was conducted to estimate the association between intervention and hospital length of stay adjusted for differences in patient demographics. Mean age of the study population was 58.6 years, 23% were African Americans and 55% were women. A significant reduction in ED boarding time (p < 0.001) and improvement in early (before 2 PM) hospital discharges (p = 0.01) were noticed among patients in the intervention groups. There was a slight but significant reduction in hospital length of stay for observation patients in the intervention group; however, no such difference was noted for inpatient admissions. Our study showed that dedicating nursing resources towards ED-boarded patients and early inpatient discharges can significantly improve hospital workflow and reduce hospital length of stay.
KW - ED boarding time
KW - Early hospital discharges
KW - Hospital length of stay
KW - Hospital workflow
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U2 - 10.1007/s11739-018-1786-1
DO - 10.1007/s11739-018-1786-1
M3 - Article
C2 - 29335822
AN - SCOPUS:85041854858
VL - 13
SP - 923
EP - 931
JO - Internal and Emergency Medicine
JF - Internal and Emergency Medicine
SN - 1828-0447
IS - 6
ER -