The Impact of a Flexible Care Area on Throughput Measures in an Academic Emergency Department

McGrath, Jayne K.; LeGare, Anne; Hermanson, Leigh; Repplinger, Michael D.

doi:10.1016/j.jen.2015.06.002

Cited by 10 publications

(10 citation statements)

References 10 publications

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“…Previously, we have shown that using this flow model decreases overall length of stay (LOS) for all ED patients with emergency severity index (ESI) levels 3 and 4. 3 These data are in line with national trends showing that front-end changes, such as fast track and vertical flow, have decreased delays in care. 2 , 4 …”

Section: Introductionsupporting

confidence: 76%

“…Though the overall impact of FCA on LOS and patient satisfaction scores for those not seen in FCA was not part of this study, we previously reported that the implementation of the FCA did lead to decreased LOS for those patients. 3 …”

Section: Limitationsmentioning

confidence: 99%

“… 2 A number of departments have used a model in the ED that focuses on “vertical patient flow,” in which patients can be evaluated, managed, and rendered a disposition in the setting of the waiting room and without occupying a traditional ED bed. 3 Outside of the ED, other targets have included downstream processes such as facilitating hospital discharges and smoothing elective surgical scheduling.…”

Section: Introductionmentioning

confidence: 99%

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The Impact of an Emergency Department Front-End Redesign on Patient-Reported Satisfaction Survey Results

Repplinger

Ravi

Lee

et al. 2017

WestJEM

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IntroductionFor emergency department (ED) patients, delays in care are associated with decreased satisfaction. Our department focused on implementing a front-end vertical patient flow model aimed to decrease delays in care, especially care initiation. The physical space for this new model was termed the Flexible Care Area (FCA). The purpose of this study was to quantify the impact of this intervention on patient satisfaction.MethodsWe conducted a retrospective study of patients discharged from our academic ED over a one-year period (7/1/2013–6/30/2014). Of the 34,083 patients discharged during that period, 14,075 were sent a Press-Ganey survey and 2,358 (16.8%) returned the survey. We subsequently compared these survey responses with clinical information available through our electronic health record (EHR). Responses from the Press-Ganey surveys were dichotomized as being “Very Good” (VG, the highest rating) or “Other” (for all other ratings). Data abstracted from the EHR included demographic information (age, gender) and operational information (e.g. – emergency severity index, length of stay, whether care was delivered entirely in the FCA, utilization of labs or radiology testing, or administration of opioid pain medications). We used Fisher’s exact test to calculate statistical differences in proportions, while the Mantel-Haenszel method was used to report odds ratios.ResultsOf the returned surveys, 62% rated overall care for the visit as VG. However, fewer patients reported their care as VG if they were seen in FCA (53.4% versus 63.2%, p=0.027). Patients seen in FCA were less likely to have advanced imaging performed (12% versus 23.8%, p=0.001) or labs drawn (24.8% vs. 59.1%, p=0.001). Length of stay (FCA mean 159 ±103.5 minutes versus non-FCA 223 ±117 minutes) and acuity were lower for FCA patients than non-FCA patients (p=0.001). There was no statistically significant difference between patient-reported ratings of physicians or nurses when comparing patients seen in FCA vs. those not seen in FCA.ConclusionPatients seen through the FCA reported a lower overall rating of care compared to patients not seen in the FCA. This occurred despite a shorter overall length of stay for these patients, suggesting that other factors have a meaningful impact on patient satisfaction.

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Section: Introductionsupporting

confidence: 76%

Section: Limitationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Impact of an Emergency Department Front-End Redesign on Patient-Reported Satisfaction Survey Results

Repplinger

Ravi

Lee

et al. 2017

WestJEM

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“…These potential solutions mainly concentrated on ‘front-ending’ care earlier in the patient journey by providing earlier physician assessment [ 21 , 23 , 38 , 50 , 63 , 65 , 67 , 71 ], including physician-led triage [ 25 , 40 , 45 , 47 , 60 ]. Dividing patients by level of acuity on arrival has also been successful in increasing throughput times, whether by opening a fact-track or flexible care area for lower acuity presenters [ 42 , 55 ], or dividing patients within the same triage code [ 34 ]. Other throughput interventions included reducing the turnaround-time of laboratory tests [ 26 , 27 , 52 , 53 , 66 ], the introduction of an ED nurse flow coordinator [ 35 , 44 , 69 ], increasing medical and nursing staff numbers in the ED [ 69 ], bedside registration immediately following triage [ 68 ], nurse initiated protocols [ 28 ], strategies to ensure earlier review by admitting teams [ 49 ] and increasing bed numbers in the ED [ 57 , 69 ].…”

Section: Resultsmentioning

confidence: 99%

Emergency department crowding: A systematic review of causes, consequences and solutions

et al. 2018

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BackgroundEmergency department crowding is a major global healthcare issue. There is much debate as to the causes of the phenomenon, leading to difficulties in developing successful, targeted solutions.AimThe aim of this systematic review was to critically analyse and summarise the findings of peer-reviewed research studies investigating the causes and consequences of, and solutions to, emergency department crowding.MethodThe Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. A structured search of four databases (Medline, CINAHL, EMBASE and Web of Science) was undertaken to identify peer-reviewed research publications aimed at investigating the causes or consequences of, or solutions to, emergency department crowding, published between January 2000 and June 2018. Two reviewers used validated critical appraisal tools to independently assess the quality of the studies. The study protocol was registered with the International prospective register of systematic reviews (PROSPERO 2017: CRD42017073439).ResultsFrom 4,131 identified studies and 162 full text reviews, 102 studies met the inclusion criteria. The majority were retrospective cohort studies, with the greatest proportion (51%) trialling or modelling potential solutions to emergency department crowding. Fourteen studies examined causes and 40 investigated consequences. Two studies looked at both causes and consequences, and two investigated causes and solutions.ConclusionsThe negative consequences of ED crowding are well established, including poorer patient outcomes and the inability of staff to adhere to guideline-recommended treatment. This review identified a mismatch between causes and solutions. The majority of identified causes related to the number and type of people attending ED and timely discharge from ED, while reported solutions focused on efficient patient flow within the ED. Solutions aimed at the introduction of whole-of-system initiatives to meet timed patient disposition targets, as well as extended hours of primary care, demonstrated promising outcomes. While the review identified increased presentations by the elderly with complex and chronic conditions as an emerging and widespread driver of crowding, more research is required to isolate the precise local factors leading to ED crowding, with system-wide solutions tailored to address identified causes.

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“…The impact of flexible care area on throughput measures inan academic emergency Departament. 16 Avaliar a aplicação de protocolos para reduzir o tempo de atendimento na emergência.…”

Section: Academic Emergency Medicine 2016unclassified

Atendimento E Gestão Como Indicador De Qualidade No Serviço De Emergência: Revisão De Literatura

Filho¹,

Sousa²,

Lima³

et al. 2018

RIB

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O acolhimento com classificação de risco é a ferramenta preconizada pelo Ministério da Saúde nos serviços de emergências para facilitar o tempo de atendimentos e as prioridades de acordo com o grau de gravidade de cada situação. Assim, a avaliação e o monitoramento da qualidade dos serviços de acolhimento na urgência e emergência são indispensáveis na melhoria do atendimento ao usuário que procura o serviço hospitalar de emergência. A revisão incluiu estudos do tipo artigos e periódicos publicados entre 2013 e 2017, indexados nas bases de dados do Literatura Latino-americana e do Caribe em Ciências da Saúde (LILACS), Scientific Eletronic Library Online (SCIELO) e Biblioteca Virtual em Saúde (BVS). Os resultados demonstram uma nova realidade de ambientes e parâmetros de trabalho, identificando aspectos de condições inadequadas e ausência de prioridades em atendimentos graves. Destacando a gestão do cuidado por equipes multiprofissionais, ampliando responsabilidades. Dentre os principais enfoques abordados na realidade encontrada, é de suma importância a identificação de necessidades da estrutura física e de capacidade profissional, priorizando o usuário dentro de uma gestão com qualidade no atendimento.

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The Impact of a Flexible Care Area on Throughput Measures in an Academic Emergency Department

Cited by 10 publications

References 10 publications

The Impact of an Emergency Department Front-End Redesign on Patient-Reported Satisfaction Survey Results

The Impact of an Emergency Department Front-End Redesign on Patient-Reported Satisfaction Survey Results

Emergency department crowding: A systematic review of causes, consequences and solutions

Atendimento E Gestão Como Indicador De Qualidade No Serviço De Emergência: Revisão De Literatura

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