Emergency department flow and the boarded patient: How to get admitted patients upstairs

Greene, J

doi:10.1016/j.annemergmed.2006.11.020

Cited by 32 publications

(31 citation statements)

References 2 publications

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“…28,29 Other unconventional solutions by some hospitals include sending admitted patients to the unit's hallways or placing discharged patients in the hallway while waiting for transportation so that the ED bed will be readily available. 30 The ED hospitalist is well-situated to have an impact on several key hospital outcomes. As the ED hospitalist role was shown to affect processes that relate to ED throughput, it is possible that the role will improve ED overcrowding and decrease ED LOS.…”

Section: Discussionmentioning

confidence: 99%

A model of a hospitalist role in the care of admitted patients in the emergency department

Briones

Markoff

Kathuria

et al. 2010

Journal of Hospital Medicine

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Section: Discussionmentioning

confidence: 99%

A model of a hospitalist role in the care of admitted patients in the emergency department

Briones

Markoff

Kathuria

et al. 2010

Journal of Hospital Medicine

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“…3 In fact, surveys have reported that patients prefer to wait in the hallways of the inpatient ward rather than in the hallways of the ED, 7,50,51 and it is estimated that this idea has spread to hundreds of hospitals nationwide. 49 Once patients have been admitted to inpatient hallways, inpatient ward staff have been able to more promptly identify inpatient beds for these admitted patients than if they had remained in the ED. 10 Despite the success of this practice elsewhere, moving boarded ED patients to inpatient hallways is prohibited by regulatory issues in California.…”

Section: Discussionmentioning

confidence: 99%

“…35,41,48 One successful method for reducing admit wait times is to take admitted ED patients who would otherwise be boarded in ED hallways and move them directly to the hallways of their designated inpatient floors while they await open beds. 49 This practice has been implemented in some areas of the United States and was shown to be safe. 3 In fact, surveys have reported that patients prefer to wait in the hallways of the inpatient ward rather than in the hallways of the ED, 7,50,51 and it is estimated that this idea has spread to hundreds of hospitals nationwide.…”

Section: Discussionmentioning

confidence: 99%

Reduction of Admit Wait Times: The Effect of a Leadership‐based Program

Patel

Combs

Vinson

2014

Academic Emergency Medicine

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Objectives: Prolonged admit wait times in the emergency department (ED) for patients who require hospitalization lead to increased boarding time in the ED, a significant cause of ED congestion. This is associated with decreased quality of care, higher morbidity and mortality, decreased patient satisfaction, increased costs for care, ambulance diversion, higher numbers of patients who leave without being seen (LWBS), and delayed care with longer lengths of stay (LOS) for other ED patients. The objective was to assess the effect of a leadership-based program to expedite hospital admissions from the ED.Methods: This before-and-after observational study was undertaken from 2006 through 2011 at one community hospital ED. A team of ED and hospital leaders implemented a program to reduce admit wait times, using a computerized hospital-wide tracking system to monitor inpatient and ED bed status. The team collaboratively and consistently moved ED patients to their inpatient beds within an established goal of 60 minutes after an admission decision was reached. Top leadership actively intervened in real time by contacting staff whenever delays occurred to expedite immediate solutions to achieve the 60-minute goal. The primary outcome measures were the percentage of ED patients who were admitted to inpatient beds within 60 minutes from the time the beds were requested and ED boarding time. LOS, patient satisfaction, LWBS rate, and ambulance diversion hours were also measured.Results: After ED census, hospital admission rates, and ED bed capacity were controlled for using a multivariable linear regression analysis, the admit wait time reduction program contributed to an increase in patients being admitted to the hospital within 60 minutes by 16 percentage points (95% confidence intervals [CI] = 10 to 22 points; p < 0.0001) and a decrease in boarding time per admission of 46 minutes (95% CI = 63 to 82 minutes; p < 0.0001). LOS decreased for admitted patients by 79 minutes (95% CI = 55 to 104 minutes; p < 0.0001), for discharged patients by 17 minutes (95% CI = 12 to 23 minutes; p < 0.0001), and for all patients by 34 minutes (95% CI = 25 to 43 minutes; p < 0.0001). Patient satisfaction increased 4.9 percentage points (95% CI = 3.8 to 6.0 points; p < 0.0001). LWBS patients decreased 0.9 percentage points (95% CI = 0.6 to 1.2 points; p < 0.0001) and monthly ambulance diversion decreased 8.2 hours (95% CI = 4.6 to 11.8 hours; p < 0.0001).Conclusions: A leadership-based program to reduce admit wait times and boarding times was associated with a significant increase in the percentage of patients admitted to the hospital within 60 minutes and a significant decrease in boarding time. Also associated with the program were decreased ED LOS, LWBS rate, and ambulance diversion, as well as increased patient satisfaction.ACADEMIC EMERGENCY MEDICINE 2014; 21:266-273

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“…Moreover, a variety of interesting consensus documents recommending how to improve patient flow have also been published [54][55][56][57][58] . However, evidence-based experiences testing these strategies are still very limited to date [15,16] , being the uniform conclusion of most of them that it's all about to increase the number of available inpatient beds, while waiting for system-wide solutions [23,[59][60][61] .…”

Section: Discussionmentioning

confidence: 99%

Alternatives to conventional hospitalization for improving lack of access to inpatient beds: a 12-year cross-sectional analysis

Corbella

Ortiga²,

Juan³

et al. 2012

JHA

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Background/Objective: When hospitals cannot guarantee available hospital beds for inpatient admission, patients are exposed to prolonged waits, cancellations and diversions that negatively affect their safety and quality of care. The purpose of this study was to evaluate the effect of a multifaceted intervention for eliminating inpatient access delays.Methods: By using multi-time point cross-sectional analysis, data from all hospitalizations from adult patients registered at an 850-bed public, tertiary-care university hospital were compared from

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Emergency department flow and the boarded patient: How to get admitted patients upstairs

Cited by 32 publications

References 2 publications

A model of a hospitalist role in the care of admitted patients in the emergency department

A model of a hospitalist role in the care of admitted patients in the emergency department

Reduction of Admit Wait Times: The Effect of a Leadership‐based Program

Alternatives to conventional hospitalization for improving lack of access to inpatient beds: a 12-year cross-sectional analysis

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