Implementation of hospital‐wide reform at improving access and flow: Impact on time to antibiotics in the emergency department

Abstract

Following implementation of hospital-wide reform directed at mitigating ED overcrowding through improved access and flow, times to administration of antibiotics were significantly reduced. These findings suggest that improved quality of care in this area may be achieved with processes aimed at improved hospital access and flow. Ongoing evaluation and vigilance is necessary to ensure sustainability and drive further improvements.

Challenges, consequences, and lessons for way–outs to emergencies at hospitals: a systematic review study

“…Operational level strategies and tactics• Developing evidence-based admission criteria [21]• Implementing Electronic Blockage System (EBS) [99]• Implementing smoothing strategy [100]• Using capacity alert escalation calls [20]• Applying Discrete Event Simulation (DES) model [22]• Improving leadership of ED [101]• Implementing contingency strategy [102]• Using management-support multimodal hospital-wide interventions [103]• Implementing four-hour-rule for emergency care [104]• Introducing of Stat Lab [105]• Implementing Code Help Regulation [106]• Using a dashboard to provide real-time information about crowding [107]c. Service delivery process• Acute care emergency surgery service provision [108]• Whole week emergency service delivery [109]• Implementing triage by physicians [110]• Introducing efficient patient discharging process [111]• High-turnover utility bed management [112]• Implementing Timely Quality Care [113]• Implementing an improved ED patient flow [114]d. Other services• Enhanced primary care [21, 115]• Optimizing translation services [21]e.…”

“…The practice of triage by physicians reduce the patients LWBS in the EDs [110]. Other interventions which contribute to the reduction of crowding included whole week emergency service delivery [109] and implementing Timely Quality Care [113]. Other services: Improving other services such as enhancing primary care [21, 115], optimizing translation services concerning patients’ issues [21] and an engagement on specialists in the outpatient environment [116, 117] contribute to the reduction of ED LOS and crowding. Premises: The high emergency patient flow forced the healthcare delivery system to address related issues.…”

“…The practice of triage by physicians reduce the patients LWBS in the EDs [110]. Other interventions which contribute to the reduction of crowding included whole week emergency service delivery [109] and implementing Timely Quality Care [113].…”

“…Initiating an acute care emergency surgery service, improving ED patient flow, and introducing an efficient patient discharging process [108, 111, 114] were recommended interventions targeting improvement in service delivery processes and reduction in ED bed occupancy rate and LOS. High-turnover utility bed management [112], practicing triage by physicians [110], whole week emergency service delivery [109], and implementing Timely Quality Care [113] were also frontline interventions that contribute to improved service delivery and reduced crowding. A recent systematic review also identified different crowding measure, social interventions, fast track, and ED nurse flow coordinator as operational level solutions to ED crowding [11].…”

Differences in Documented and Actual Medication Administration Time in the Emergency Department: A Prospective, Observational, Time-Motion Study

“…15 In the currently published research literature, only 2 observational studies have reported prospective time-to-treatment measurement. 23,24 However, both studies did not actually compare medication documentation time with medication administration time. Roman et al 23 described the effects of a hospital-wide reform to improve timely delivery of antibiotics, while Miner et al 24 only investigated the effects of oral vs intravenous opioids on medication times.…”