My article was on improving patient flow and crowding in the ED. This research article used a cross sectional study over a 9 month period for pre intervention analysis and then another 9 month period post intervention. The researchers looked at radiology turnaround, length of stay, unscheduled return visits and number of patients that left the ED without being seen. This study was conducted at a Dutch level 1 trauma center neuro vascular that saw on average 54,000 patients a year. Interventions that were used included the addition of a emergency NP, 5 medical specialist available during peak hours, a 5 day lean program of the radiology department and having inpatient staff pick up their patient within 30 mins of an admission decision. Following these interventions length of stay decreased by 13 mins and patients leaving without being seen decreased from 348-270 patients.
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Emergency department face a lot of challenges in order to deliver high quality and timely patient care. This is because of the increasing number of patients coming to the emergency department and some of these patients will leave without receiving care. Nurse-led triage is the standard model in the emergency departments all over the world. A research was done to identify evidence -based interventions in reducing the amount of time patients spend in the emergency department and improve patient flow. It had been shown that the use of doctor-led triage at the emergency department will enhance rapid assessment and help to improve patient flow. It had also been shown that point of care testing if used effectively has shown to reduce patient time in the emergency department (Jarvis, 2016).
References
Jarvis, P. R. (2016, June 30). Improving emergenct department patient flow. Retrieved July 6, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5051606/
Jarvis, P. R. (2016, June 30). Improving emergency department patient flow. Retrieved July 6, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5051606/
I find this article very intriguing, as I worked ED the majority of my career up to the past 3 years. I would love to see them do a study in the US and see if there would be a difference in how they would respond with the results. Based off of experience in the past, the majority of the ED’s that I worked in always had difficulty with turn around times due to the “numbers game”. Sending staff home and working off of a skeleton crew, then getting a ton of patients walking in, or several ED’s have attempted to utilize nurses to perform MSE’s to assist with the turn around times as well. This is in the more rural emergency rooms where the physician is on call and is being called in.
http://www.cms.gov
High ED traffic and long waits can be awful on the facilities, staff and patients. Unfortunately right now, the numbers of people going to the ER to primary care needs doesn’t seem to be on the decline and likely won’t be in the future. I have seen several EDs implement a ‘fast track’ ER for minor complaints and primary care type needs. Since EMTALA requires the ERs to see all of the presenting patients, the fast track rooms worked with a mid level, one RN and usually a tech to get the minor complaints in and out quickly. Although the triage system would cut the wait time down for people with actual emergency needs, the minor needs patient still clog the ER and the fast track greatly helped.
While looking at being more efficient is important, it is also very important to look at why so many people utilize the ER instead of a clinic setting. According to this study, almost 75% of all ER visits are non-emergent. This is defined as “not a threat to life or limb.” If more of these patients used walk in clinics or convenient care, it would improve the response time to the other patients in the ER.
Abdallat, A.M., Al Samadi, I. & Abbadi, M.D. (2000). Who uses the emergency room services?. EMHJ – Eastern Mediterranean Health Journal, 6 (5-6), 1126-1129, 2000 https://apps.who.int/iris/handle/10665/118979
Hi Mychala, I enjoyed reading your Journal club post. The topic of your article was interesting to me because so many times emergency departments are inundated with non-emergent cases which can have dangerous consequences for patients that truly do need emergency medical attention. When considering why emergency departments are always so busy, I think it is important to also acknowledge the coverage that some insurance companies provide. My first thought was that the people who go to the emergency department for non-emergent medical treatment might not have any health insurance. On the contrary, at times patients who frequent emergency departments have great insurance coverage. Perhaps, too great? A colleague once told me that some patients are over-insured. In other words, it is cheaper for them to seek healthcare services via the emergency department than it would be to make an appointment at a clinic. I honestly have no idea if there is any truth to that because I have never had health insurance like that! Great article and research topic, thanks for sharing!
ED put-through is an important topic. Our facility is currently trying to get the put-through time form ED to bed in under 60 minutes. They are trying to research what are some of the barriers to this being accomplished and tracking them for a few months to get feedback. I recall reading an article a while back that discussed the idea of having more clinics right next to the ED, similar to a “fast track” program. That way minor emergencies can be sent over there instead of taking time away from the emergent cases. The article I found today, actually discusses how living near Retail Clinics helps to cut down on ED visits (Heath, 2019). However, you are still left with the problem of staffing. Most clinics are 7-6 and we all know that most people visit the ED outside of those hours. There are also the staffing issues in the ED where RN’s are sent home, and then the ED gets inundated with patients with no staff to help cover. Not sure what the solution is to this issue. Thanks for sharing your research article!
Heath, S. (2019, December 19). Proximity to Retail Clinic Cuts Emergency Department Utilization. PatientEngagementHIT. https://patientengagementhit.com/news/proximity-to-retail-clinic-cuts-emergency-department-utilization.
The topic you chose was a great one! Over-crowding in emergency departments is becoming more of a problem as time goes on. Many ER’s have started to implement “fast track” or “vertical care” processes to expedite non-critical patients care, to decrease wait times. In the research I have found, a seperate area was created for “vertical patients. They chose to “Define criteria to identify appropriate patients. A key factor for the success of this new area was the appropriate triage of patients in the waiting area and work between the hours of 11am to 11pm.” This allowed them to have a 90 minute or less turn around time with low acuity patients and create more room for the higher acuity patients.
Haller, Whitney, and Vicky Hogue. “Fast-track treatment in the Emergency Room.” Healthcare Design Jan. 2011: 22+. Business Insights: Global. Web. 12 July 2020.
Emergency stay times are always be critiqued and highly linked to patient satisfaction. Hospitals seem to always be looking for common factors to why patient stays are long and providers are often critiqued told to treat them and street them. It can be frustrating as someone working in the ED to not feel can spend the time treating those patients because worried about the times or worried about the patients who will complain about wait times etc. Plus there are so many factors to the ED stay, like a trauma or other critical patient coming in and taking the resources at that time, adding to the length of stay for those others or AMA/Elopements happening.
Traumatol, C. (2019, June 22). The emergency department length of stay: Is the time running out? PubMed Central (PMC). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6543458/
Not only are emergency rooms in densely populated areas a complicated process to fix, it is also dangerous to the patients being admitted. In addition to this, the emergency department cares are incredibly expensive and the hospital almost always hemorrhages money through the emergency department. although it is an essential service, it is abused as a clinic as well. Healthcare reform has enabled this and it does not seem that the situation will get any better. Insitiution of a bed managment system that triages patients does help this problem (Barrett, Ford, & Ward-Smith, 2012).
Barrett, L., Ford, S., & Ward-Smith, P. (2012). A Bed Management Strategy For Overcrowding In the Emergency Department. Nursing Economic$, 30(2), 82–86.
Overcrowding in the ED is a huge issue nation wide. Some consequences of overcrowding in the ED are: 1. Truly sick people are having to wait too long to receive care, 2. Increase in total length of hospital stay with increase in longer ED visit, 3. Increase in AMA patients and patient elopment, 4. Reduction in quality of care, 5. Increase in medical errors, 6. Increase in mortality. One study shows that one of the biggest causes of overcrowding is admission overflow. When patients needing admitted to another floor but there is a shortage of beds, this is one of the largest causes of overcrowding (Salway et al., 2017).
References:
Salway, R. J., Valenzula, R., Shoenberger, J. M., Mallon, W. K., & Vicellio, A. (2017). Emergency department (Ed) overcrowding: Evidence-based answers to frequently asked questions. ScienceDirect.com | Science, health and medical journals, full text articles and books. https://www.sciencedirect.com/science/article/pii/S0716864017300354
I really enjoyed your article, it can be very challenging to not only get to patients promptly but triage and treat them as appropriate. Prolonged ER visits are associated with adverse outcomes for patients as well as patient satisfaction and increased costs to the patient and the department (Every Minute Counts: Using Process Improvement and Performance Feedback to Improve Patient Flow in an Emergency Department 2018). Reduction in door-to order times and door- to discharge times by using standard order sets can improve patient satisfaction.
Every Minute Counts: Using Process Improvement and Performance Feedback to Improve Patient Flow in an Emergency Department. (2018, January 17). Retrieved July 11, 2020, from https://www.tandfonline.com/doi/abs/10.1080/01608061.2017.1423150