A Hospitalist-Led Team to Manage Patient Boarding in the Emergency Department: Impact on Hospital Length of Stay and Cost

Hrycko, Alexander; Tiwari, Vishal; Vemula, Murali; Donovan, Ashley; Scibelli, Christine; Joshi, Kirti; Visintainer, Paul; Stefan, Mihaela

doi:10.14423/smj.0000000000001043

Cited by 6 publications

(5 citation statements)

References 9 publications

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“…A study from the USA found patients who experienced an ED LOS greater than 6 hours while waiting for an inpatient bed were more likely to experience an adverse event in the ED 14. Increased LOS and overcrowding in the ED is recognised worldwide to have a negative impact on patient safety, adversely affecting the clinical care delivered to patients and leading to an increase in inpatient hospital LOS and mortality risk 10 13–15 19–22 46–49. To decrease ED LOS in Australia, National Emergency Access Targets (NEAT) were introduced in 2012 19 50.…”

Section: Discussionmentioning

confidence: 99%

“…The emergency department (ED) is a unique environment within the hospital, the ED by nature is busy and chaotic, and multiple factors may increase the risk of a CI occurring during a patient’s stay in ED 6–9. Issues such as overcrowding due to surges of patient presentations, multitraumas and other high acuity presentations, multiple handovers and patient movements in the ED, and lack of available inpatient beds can compromise patient safety 1 8–15. For the patient who has experienced a CI in the ED the impact from the event can be substantial, leading to increased length of clinical observation and further treatment, unplanned hospital admission and increased hospital length of stay (LOS) 12 16–18.…”

Section: Introductionmentioning

confidence: 99%

“…For the patient who has experienced a CI in the ED the impact from the event can be substantial, leading to increased length of clinical observation and further treatment, unplanned hospital admission and increased hospital length of stay (LOS) 12 16–18. Overcrowding and increased LOS in the ED is recognised globally to negatively impact patient safety, leading to an increase in mortality risk and adversely affecting the clinical care delivered to patients while in the ED 13–15 19–22. The role of nursing work systems as part of HFE in the ED is also crucial to examine, as nursing performance and quality of care delivered is closely linked with patient outcomes 23.…”

Section: Introductionmentioning

confidence: 99%

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Clinical incidents in the emergency department: is there an association with emergency nursing shift patterns? A retrospective observational study

Roberts

Thom

Hocking³

et al. 2022

BMJ Open Qual

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IntroductionClinical incident (CI) management within healthcare settings is a crucial component of patient safety and quality improvement. The complex environment in the emergency department (ED) and nursing work schedules are important aspects of human factor ergonomic (HFE) systems that requires closer examination. Nursing shifts are closely related to fatigue, including the late/early shift pattern and night shift. All nursing shifts were examined over a 1-year period when a CI occurred to a patient in the ED to identify if there was an association.MethodsThis was a retrospective observational study, conducted and reported using the Strengthening of the Reporting of Observational Studies in Epidemiology statement. All CIs reported in the ED over a 1-year period were reviewed by accessing the CI database, emergency department information system and patient health records. The nursing roster database was accessed to record nursing shifts and were de-identified.ResultsA total of n=244 CIs were eligible for inclusion into the study. ED nursing shift analysis included n=1095 nursing shifts. An analysis of early, late and night shifts, including days not worked by the ED nurse was conducted over a 48-hour and 96-hour period. There was no significant relationship identified between the CI and nursing shift patterns. ED length of stay (LOS) was significantly higher for a patient presentation when a CI occurred.ConclusionThis study focused on the HFE system of nursing work schedules and CI events that occurred in the ED. This study found there was no relationship between emergency nursing shift patterns and an increased risk for the occurrence of a CI in the ED. Although a strong link was found between patients experiencing a CI in the ED and an extended LOS. This demonstrates the need for studies to investigate the interrelationships of multiple HFE systems in the ED, including the environment, patient, clinical team and organisational factors.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clinical incidents in the emergency department: is there an association with emergency nursing shift patterns? A retrospective observational study

Roberts

Thom

Hocking³

et al. 2022

BMJ Open Qual

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“…Association exists between ED boarding times and inpatient hospital costs, 24 and cost‐savings occur by decreasing ED boarding times. 25 , 26 Boarding times were ≈1 hour for both home hospital and usual care arms in recent home hospital trials, 19 , 20 which were substantially shorter than the national average. Home hospital transfers are not reliant on hospital resources.…”

Section: What Is Home Hospital?mentioning

confidence: 95%

“…Indirect cost savings from reduced ED boarding may also be achieved with home hospital dissemination. Association exists between ED boarding times and inpatient hospital costs, 24 and cost‐savings occur by decreasing ED boarding times 25,26 . Boarding times were ≈1 hour for both home hospital and usual care arms in recent home hospital trials, 19,20 which were substantially shorter than the national average.…”

Section: What Is Home Hospital?mentioning

confidence: 99%

Home hospital as a disposition for older adults from the emergency department: Benefits and opportunities

et al. 2021

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The $1 trillion industry of acute hospital care in the United States is shifting from inside the walls of the hospital to patient homes. To tackle the limitations of current hospital care in the United States, on November 25, 2020, the Center for Medicare & Medicaid Services announced that the acute hospital care at home waiver would reimburse for “home hospital” services. A “home hospital” is the home‐based provision of acute services usually associated with the traditional inpatient hospital setting. Prior work suggests that home hospital care can reduce costs, maintain quality and safety, and improve patient experiences for select acutely ill adults who require hospital‐level care. However, most emergency physicians are unfamiliar with the evidence of benefits demonstrated by home hospital services, especially for older adults. Therefore, the lead author solicited narrative inputs on this topic from selected experts in emergency medicine and home hospital services with clinical experience, publications, and funding on home hospital care. Then we sought to identify information most relevant to the practice of emergency medicine. We outline the proven and potential benefits of home hospital services specific to older adults compared to traditional acute care hospitalization with a focus on the emergency department.

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Stakeholder insight into the creation, implementation, and current practices of an emergency department hospitalist team

Shreffler

McGee

Wojcik

et al. 2022

The American Journal of Emergency Medicine

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A Hospitalist-Led Team to Manage Patient Boarding in the Emergency Department: Impact on Hospital Length of Stay and Cost

Cited by 6 publications

References 9 publications

Clinical incidents in the emergency department: is there an association with emergency nursing shift patterns? A retrospective observational study

Clinical incidents in the emergency department: is there an association with emergency nursing shift patterns? A retrospective observational study

Home hospital as a disposition for older adults from the emergency department: Benefits and opportunities

Stakeholder insight into the creation, implementation, and current practices of an emergency department hospitalist team

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