Emergency department clinical redesign, team‐based care and improvements in hospital performance: A time series analysis

Abstract

An ED-focused clinical redesign project was associated with a 17% improvement in NEAT performance with no evidence of an increase in clinical deterioration on inpatient wards and evidence for an improvement in hospital mortality.

Effects of a hospital‐wide intervention on emergency department crowding and quality: A prospective study

“…There is ample evidence that ED crowding can be reduced by hospital-wide 6,7 and system-wide 8,9 interventions and some evidence of resultant improvement in patient outcomes including mortality. [10][11][12] There are conflicting reports on whether reducing patient time in the ED is associated with increased return visits 7,9,10 and there is evidence for an optimal level of short ED times. 13 In Australia, much of the recent evidence was derived during the period of Western Australia's '4 h rule' driven by a single State Health Department and the nationwide 'National Emergency Access Target' (NEAT).…”

Two Hour Evaluation and Referral Model for Shorter Turnaround Times in the emergency department

“…The same department later adopted a more elaborate model of care that paired multiple medical teams with specialist supervisors to provide early consultation. 22 Time series analysis demonstrated a 17% gain in NEAT compliance; however, the average EDLOS was reduced by only 37 min and the contribution of additional short stay unit beds and other flow initiatives was not considered. Despite additional specialist numbers, there was no requirement for senior referral nor a specified disposition target.…”

“…While strategies such as clinical streaming, team‐based assessment and early senior consultation have been employed elsewhere, we believe that THERMoSTAT is the first system to refine these elements and combine them with the forcing function of periodic turnover. Cubicles are recycled in a more proactive manner in order to preserve capacity and suppress the development of queues.…”

“…Despite limited numbers, the authors concluded that the introduction of such a strategy in isolation could not improve outcomes for admitted patients. The same department later adopted a more elaborate model of care that paired multiple medical teams with specialist supervisors to provide early consultation . Time series analysis demonstrated a 17% gain in NEAT compliance; however, the average EDLOS was reduced by only 37 min and the contribution of additional short stay unit beds and other flow initiatives was not considered.…”

Collaborative research between emergency medicine and physicians

“…argue internally led clinical process redesign leads to superior and sustained improvements in ED access block. Furthermore, clinical redesign, team‐based care and ED initiatives implemented internally improved NEAT compliance without incurring the risk of prematurely transferring unstable patients to inpatient wards . A time series analysis of hospital‐wide performance at Sydney's Royal Prince Alfred Hospital would not be possible without cooperation between ED and inpatient units.…”