The impact of delays to admission from the emergency department on inpatient outcomes

Abstract

BackgroundWe sought to determine the impact of delays to admission from the Emergency Department (ED) on inpatient length of stay (LOS), and IP cost.MethodsWe conducted a retrospective analysis of 13,460 adult (≥ 18 yrs) ED visits between April 1 2006 and March 30 2007 at a tertiary care teaching hospital with two ED sites in which the mode of disposition was admission to ICU, surgery or inpatient wards. We defined ED Admission Delay as ED time to decision to admit > 12 hours. The primary outcomes were IP LOS, and total IP cost.ResultsApproximately 11.6% (n = 1558) of admitted patients experienced admission delay. In multivariate analysis we found that admission delay was associated with 12.4% longer IP LOS (95% CI 6.6% - 18.5%) and 11.0% greater total IP cost (6.0% - 16.4%). We estimated the cumulative impact of delay on all delayed patients as an additional 2,183 inpatient days and an increase in IP cost of $2,109,173 at the study institution.ConclusionsDelays to admission from the ED are associated with increased IP LOS and IP cost. Improving patient flow through the ED may reduce hospital costs and improve quality of care. There may be a business case for investments to reduce emergency department admission delays.

Time Based Management in Health Care System: The Chosen Aspects

“…Jak wykazały kilkuletnie badania, wydłużony czas oczekiwania pacjentów na przyjęcia w izbie przyjęć podaje połowa szpitali badanych w USA (36). Badania miały na celu analizę kilku metod przyjmowania pacjentów w izbach przyjęć w wybranych szpitalach i szukanie korelacji między każdą z nich w aspekcie utraconych korzyści z powodu oczekiwania pacjentów na przyjęcie.…”

“…Odnotowano zależność liniową między wydłużają-cym się czasem oczekiwania na przyjęcie i wzrostem tzw. utraconych korzyści (36). Znaczące opóźnienia w przepływie pacjentów w izbie przyjęć mają liczne negatywne konsekwencje, m.in.…”

“…W opinii Kanadyjskiego Towarzystwa Lekarzy Pogotowia Ratunkowego (Canadian Association of Emergency Physicians) przepełnienie szpitala ma natychmiastowe konsekwencje w postaci przepełnień w izbie przyjęć (36). Pacjenci, którzy wymagają szybkiej hospitalizacji, są zmuszeni do długiego oczekiwania w izbie przyjęć, co skutkuje opóźnieniem w udzieleniu im koniecznej pomocy.…”

Cost-effectiveness of a physician-nurse supplementary triage assessment team at an academic tertiary care emergency department

“…6 A study published in 2010 concluded that ED admission delays greater than 12 hours increased inpatient LOS at an annual additional cost of 2.1 million dollars. 7 Owing to limited resources and increasing patient demand, the largest contributing factor to ED crowding is access block 1 -the "diminished access to health care." 8 This multifactorial issue has no single solution, and its resolution will require a systems-approach rather than through the ED.…”

Improvement in Delay of Information flow in Energy Efficiency Organization

“…The figures suggest that There may be a business case for interventions that improve ED flow and reduce admission delay. [4] Another approach to reduce the time delays is using FINC methodology. This methodology is designed mostly for reducing Delay rate in military in C4ISR (Command, Control, Communications, Computers, Intelligence, Surveillance, Reconnaissance) architecture by Dekker.…”