Direct-to-Room: One Department's Approach to Improving ED Throughput

Bertoty, David A.; Kuszajewski, Michele L.; Marsh, Eric E.

doi:10.1016/j.jen.2006.09.018

Cited by 14 publications

(7 citation statements)

References 10 publications

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“…In other settings, input from the ED frontline staff has contributed to innovations such as the “Direct to Room” alternative to traditional triage when an ED bed is available [24]. The results from this study demonstrate an association between clinician identified reasons for delay and actual increases in ED wait times for their patients.…”

Section: Discussionmentioning

confidence: 77%

Bottlenecks in the Emergency Department: the psychiatric clinicians' perspective

Chang

Weiss

Orav

et al. 2012

General Hospital Psychiatry

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Objective To ask psychiatric clinicians for their perspectives on the rate-limiting steps (RLS) in patient care in the Emergency Department (ED) and to compare them to the patient’s actual length of stay. Method Prospective cohort study of clinicians’ perspectives on the RLS among 1092 adult ED patients. Medical records were abstracted for ED time and other data. Results Clinicians identified five RLS: limited availability of staff, limited availability of beds after discharge, need for clinical stability, need for additional history and patient’s financial issues. The last RLS was the only one not associated with increased wait times in the ED. There were significant differences in the patterns of RLS by trainee status and hospital. For example, significantly higher proportions of trainees reported that RLS in patient care were due to the need for clinical stability and additional history and lack of bed availability. In contrast, non-trainee clinicians were more likely to cite problems with the availability of ED staff as an RLS. Conclusions Most of the RLS in patient care identified by clinicians were associated with actual increases in ED wait time for their patients. Next steps include asking clinicians for possible solutions to the delays their patients experience.

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Section: Discussionmentioning

confidence: 77%

Bottlenecks in the Emergency Department: the psychiatric clinicians' perspective

Chang

Weiss

Orav

et al. 2012

General Hospital Psychiatry

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“…However, a number of potential factors have become the focus of research: Among other things Miro et al (2003) focused on ED-layout to shorten the walking distances and promote communication. The triage and registration are another current focus of research (Bertoty 2007;Subash 2004). Providing diagnostic equipment which the ED owns (blood work, CT, X-Ray) combined with full electronic records has helped to significantly improve testing efficiency over the past decade.…”

Section: Introductionmentioning

confidence: 99%

Reducing Emergency Department overcrowding - five patient buffer concepts in comparison

Kolb¹,

Schoening²,

Lee³

2008

2008 Winter Simulation Conference

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Emergency Department (ED) overcrowding is a common medical care issue in the United States and other developed nations. One major cause of ED crowding are holding patients waiting in the Emergency Room (ER) for inpatient unit admission where they block critical ED resources. With input data from a hospital in Massachusetts/USA, we tested five patient buffer concepts which aim at relieving pressure of the ER. The buffers are also assumed to improve patient and staff satisfaction through their design tailored to needs in patient flow. To ensure patients safety, we performed tests with discrete event simulation in which we discovered 'triage to bed time' reductions of up to 22% and 'diversion hour' decreases of up to 24%. All buffers managed to run with significantly less resources than the ER. Our findings have a potential impact on hospital process flow due to clear results which offer substantial improvement of hospital organization.

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“…LH-GV was designed to facilitate direct-to-room triage with registration at bedside; a traditional waiting room was to be used only when the facility operated at capacity. 27,28 In addition, a separate results-waiting area would enable prompt and comfortable discharge of patients who were not admitted or transferred.…”

Section: Physical Designmentioning

confidence: 99%

Simulation for Operational Readiness in a New Freestanding Emergency Department

et al. 2016

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Summary StatementSimulation in multiple contexts over the course of a 10-week period served as a core learning strategy to orient experienced clinicians before opening a large new urban freestanding emergency department. To ensure technical and procedural skills of all team members, who would provide care without on-site recourse to specialty backup, we designed a comprehensive interprofessional curriculum to verify and regularize a wide range of competencies and best practices for all clinicians. Formulated under the rubric of systems integration, simulation activities aimed to instill a shared culture of patient safety among the entire cohort of 43 experienced emergency physicians, physician assistants, nurses, and patient technicians, most newly hired to the health system, who had never before worked together. Methods throughout the preoperational term included predominantly hands-on skills review, high-fidelity simulation, and simulation with standardized patients. We also used simulation during instruction in disaster preparedness, sexual assault forensics, and community outreach. Our program culminated with 2 days of in-situ simulation deployed in simultaneous and overlapping timeframes to challenge system response capabilities, resilience, and flexibility; this work revealed latent safety threats, lapses in communication, issues of intake procedure and patient flow, and the persistence of inapt or inapplicable mental models in responding to clinical emergencies.

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Direct-to-Room: One Department's Approach to Improving ED Throughput

Cited by 14 publications

References 10 publications

Bottlenecks in the Emergency Department: the psychiatric clinicians' perspective

Bottlenecks in the Emergency Department: the psychiatric clinicians' perspective

Reducing Emergency Department overcrowding - five patient buffer concepts in comparison

Simulation for Operational Readiness in a New Freestanding Emergency Department

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