Direct Admission from the Emergency Department to a Subacute Care Ward: An Alternative to Acute Hospitalization

Ang, Seng Hock; Rosario, Barbara Helen; Ngeow, Ko Yen Ivan; Koh, Xin Yu; Hamid, Seruwati Abdul; Loi, Foo Chin; Xu, Jia; Nagasayi, Subramaniam; Wilkinson, Stephen Paul; Lee, Hsiang Peng Adrian; Chow, Wai Leng; Chen, Yuan Xin Christine; Chandran, Thulasi; Lien, Christopher Tsung Chien

doi:10.1016/j.jamda.2020.05.064

Cited by 7 publications

(6 citation statements)

References 9 publications

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“…Evaluations should encompass transitions into and out of the unit, and direct entry (from the community or emergency department) is a potentially promising option. 21 This research has several limitations. First, it does not encompass all experiences with transition units across (Western) Canada.…”

Section: Discussionmentioning

confidence: 92%

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Can facility-based transitional care improve patient flow? Lessons from four Canadian regions

Kreindler

Struthers

Star

et al. 2021

Healthc Manage Forum

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Units providing transitional, subacute, or restorative care represent a common intervention to facilitate patient flow and improve outcomes for lower acuity (often older) inpatients; however, little is known about Canadian health systems’ experiences with such “transition units.” This comparative case study of diverse units in four health regions (48 interviews) identified important success factors and pitfalls. A fundamental requirement for success is to clearly define the unit’s intended population and design the model around its needs. Planners must also ensure that the unit be resourced and staffed to deliver truly restorative care. Finally, streamlined processes must be developed to help patients access and move through the unit. Units that were perceived as more effective appeared to have satisfactorily addressed these population, capacity, and process issues, whereas those perceived as less effective continued to struggle with them. Findings suggest principles to support optimal design and implementation of transition units.

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Section: Discussionmentioning

confidence: 92%

“…Evaluations should encompass transitions into and out of the unit, and direct entry (from the community or emergency department) is a potentially promising option. 21 …”

Section: Discussionmentioning

confidence: 99%

Can facility-based transitional care improve patient flow? Lessons from four Canadian regions

Kreindler

Struthers

Star

et al. 2021

Healthc Manage Forum

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“…We use attained age as the time scale for all models to eliminate the possibility of nonproportional effects of frailty driven by time-age. 7 We first fitted time-constant survival models stratified by sex to quantify the impact of frailty on all-cause mortality and causespecific mortality. Next, we tested if there were significant timedependent effects for those causes of death that were significant in the time-constant model.…”

Section: Discussionmentioning

confidence: 99%

“…Next, we tested if there were significant timedependent effects for those causes of death that were significant in the time-constant model. 7 Finally, we concentrated on continuous time-dependent effects using restricted cubic splines to quantify the association between frailty, all-cause mortality, and cause-specific mortality at age 45-86 years. For each of the approaches described above, we ran multivariate models that included some covariates: education level, employment status, income, Townsend deprivation index, ethnicity, alcohol, smoking, consumption of vegetables and fruits, consumption of meat, body mass index (BMI), fall in past year, and morbidity counts.…”

Section: Discussionmentioning

confidence: 99%

Emergency Department Staff Perceptions of Emergency Department Interventions for Frailty (EDIFY)

Baldevarona-Llego

Zhu

Chong

2022

Journal of the American Medical Directors Association

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“…The idea of streaming, although not always identified as such, underpins diverse healthcare interventions: separation of emergency from elective general surgery, 31 direct-entry subacute care, 32 risk-stratified chronic disease management, 33 stepped care for mental health, 34 and so on. Our specific findings may not apply to other interventions, some of which serve easily defined groups; deliver care virtually (not requiring designated physical space); or stream patients to facilitate ongoing targeted care, not rapid discharge.…”

Section: Original Researchmentioning

confidence: 99%

Realist analysis of streaming interventions in emergency departments

Anwar

Rowe

Metge

et al. 2021

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BackgroundSeveral of the many emergency department (ED) interventions intended to address the complex problem of (over)crowding are based on the principle of streaming: directing different groups of patients to different processes of care. Although the theoretical basis of streaming is robust, evidence on the effectiveness of these interventions remains inconclusive.MethodsThis qualitative research, grounded in the population-capacity-process model, sought to determine how, why and under what conditions streaming interventions may be effective. Data came from a broader study exploring patient flow strategies across Western Canada through in-depth interviews with managers at all levels. We undertook realist analysis of interview data from the 98 participants who discussed relevant interventions (fast-track/minor treatment areas, rapid assessment zones, diverse short-stay units), focusing on their explanations of initiatives’ perceived outcomes.ResultsEssential features of streaming interventions included separation of designated populations (population), provision of dedicated space and resources (capacity) and rapid cycle time (process). These features supported key mechanisms of impact: patients wait only for services they need; patient variability is reduced; lag time between steps is eliminated; and provider attitude change promotes prompt discharge. Conversely, reported failures usually involved neglect of one of these dimensions during intervention design and/or implementation. Participants also identified important contextual barriers to success, notably lack of outflow sites and demand outstripping capacity. Nonetheless, failure was more commonly attributed to intervention flaws than to context factors.ConclusionsWhile streaming interventions have the potential to reduce crowding, a theory-based intervention relies on its implementers’ adherence to the theory. Streaming interventions cannot be expected to yield the desired results if operationalised in a manner incongruent with the theory on which they are supposedly based.

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Direct Admission from the Emergency Department to a Subacute Care Ward: An Alternative to Acute Hospitalization

Cited by 7 publications

References 9 publications

Can facility-based transitional care improve patient flow? Lessons from four Canadian regions

Can facility-based transitional care improve patient flow? Lessons from four Canadian regions

Emergency Department Staff Perceptions of Emergency Department Interventions for Frailty (EDIFY)

Realist analysis of streaming interventions in emergency departments

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