The Impact of Emergency Department Crowding Measures on Time to Antibiotics for Patients With Community-Acquired Pneumonia

Pines, Jesse M.; Localio, A. Russell; Hollander, Judd E.; Baxt, William G.; Lee, Hoi; Phillips, Carolyn; Metlay, Joshua P.

doi:10.1016/j.annemergmed.2007.07.021

Cited by 244 publications

(164 citation statements)

References 28 publications

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“…Healthcare institutions utilize patient flow analyses to evaluate and improve aspects of the patient experience including safety, effectiveness, efficiency, timeliness, patient centeredness, and equity. [1][2][3][4][5][6][7][8] Hospitals can evaluate patient flow using specific metrics, such as time in emergency department (ED) or percent of discharges completed by a certain time of day. However, no single metric can represent the full spectrum of processes inherent to patient flow.…”

Section: Discussionmentioning

confidence: 99%

Measuring patient flow in a children's hospital using a scorecard with composite measurement

Fieldston

Zaoutis

Agosto

et al. 2014

Journal of Hospital Medicine

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BACKGROUND Although patient flow is a focus for improvement in hospitals, commonly used single or unaggregated measures fail to capture its complexity. Composite measures can account for multiple dimensions of performance but have not been reported for the assessment of patient flow. OBJECTIVES To present and discuss the implementation of a composite measure system as a way to measure and monitor patient flow and improvement activities at an urban children's hospital. METHODS A 5‐domain patient flow scorecard with composite measurement was designed by an interdisciplinary workgroup using measures involved in multiple aspects of patient flow. RESULTS The composite score measurement system provided improvement teams and administrators with a comprehensive overview of patient flow. It captured overall performance trends and identified operational domains and specific components of patient flow that required improvement. DISCUSSION A patient flow scorecard with composite measurement holds advantages over a single or unaggregated measurement system, because it provides a holistic assessment of performance while also identifying specific areas in need of improvement. Journal of Hospital Medicine 2014;9:463–468. © 2014 Society of Hospital Medicine

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Section: Discussionmentioning

confidence: 99%

Measuring patient flow in a children's hospital using a scorecard with composite measurement

Fieldston

Zaoutis

Agosto

et al. 2014

Journal of Hospital Medicine

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“…Evidence of the negative impact of crowding on the timeliness and other aspects of the quality of emergency care (i.e., safety, effectiveness, efficiency) are rapidly accumulating. [34][35][36][37][38][39][40][41][42][43] Under these circumstances, it is not prudent to take on services that are normally outside of our primary mission unless they are cost-effective and do not threaten the operational efficiency of ED care. During the study period, 6% of our patients walked out and 16% of the time the ED went on ambulance diversion as a result of crowding problems.…”

Section: Discussionmentioning

confidence: 99%

“…Crowding is associated with substantial treatment delays, even among patients with time-sensitive conditions. [34][35][36][37][38][39][40][41][42][43] Thus, unless it can be easily conducted and a substantial number of cases can be detected, it is not clear that routine screening in the ED setting for AAA is appropriate.…”

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confidence: 99%

Routine Screening for Asymptomatic Abdominal Aortic Aneurysm in High‐risk Patients Is Not Recommended in Emergency Departments That Are Frequently Crowded

Hoffmann

Bessman

et al. 2009

Academic Emergency Medicine

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Objectives: The objectives were to examine the feasibility of offering abdominal aortic aneurysm (AAA) screening to consecutive, asymptomatic high-risk patients in a busy emergency department (ED) and to compare the prevalence of undetected AAA among ED patients to the prevalence among similarly aged men from the general population.Methods: A prospective cohort study was conducted at an academic community ED with an annual census of 58,000 patients. Dedicated study coordinators attempted to approach all consecutive male ED patients >50 years who presented in June-August 2007 during hours of high patient volume. To be eligible, older males had to have a smoking history or a family history of AAA. Patients were excluded if they presented with AAA symptoms, had a previous history of AAA screening or repair, had hemodynamic instability, or had an altered mental status. Study coordinators completed a brief interview with all enrolled subjects to obtain demographic and health information. A credentialed ED provider performed the ultrasound (US) screening exam and documented all findings. The US director reviewed representative images of the sonographic exam for correct visualization and measurement during quality assurance. The ED sonographers also completed a survey regarding their attitudes toward AAA screening in the ED. The primary study outcomes were the feasibility of AAA screening in the ED (screening rate, enrollment rate, US success rate, and providers' opinions) and the prevalence of AAA (aortic diameter of ‡3.0 cm) in the study sample.Results: During the 12-week study period, the study coordinators successfully approached 96% (700 ⁄ 729) of males > 50 years who were in the ED during study enrollment hours. Of those approached, 278 were eligible (40%), 25% were ineligible, 20% were not at high risk, and for 15% we could not determine risk factor status because of altered mental status. Of the 278 eligible, 196 (70%) underwent an US exam; 10% were not scanned because the providers were too busy, and 20% declined participation. Of those scanned, the ED sonographer was able to completely visualize and correctly measure the abdominal aortas of 71% of subjects. The prevalence rate of AAA in the study sample was 5.7% (95% confidence interval [CI] = 1.9% to 9.6%), similar to reported rates of 6 or 7% in other studies. More than half of the ED sonographers reported that US screening for AAA improved the quality of ED care (58%) and patient satisfaction (63%). However, 47% reported that AAA screening reduced ED efficiency, and 74% felt that the ED was not an appropriate setting for routine AAA screening.Conclusions: Routine screening for asymptomatic AAA required substantial ED resources for a relatively low success rate of completed screens. The prevalence rate of AAA in our ED sample was not significantly different than prevalence estimates obtained from older men in the general population. ED sonographers reported benefits of screening in terms of improving the quality of emergency care and patient satisfa...

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“…56 Boarded, admitted patients have been shown to have decreased quality of care and patient satisfaction. [3][4][5] Active bed management (ABM) by hospitalists can decrease ED diversion. Howell and colleagues instituted ABM where hospitalists, as active bed managers, facilitate placement of patients to their inpatient destinations to assist ED flow.…”

Section: Active Bed Managementmentioning

confidence: 99%

“…1 With emergency department (ED) diversion reaching rates upward of 70%, lack of access to inpatient beds leads to delayed care with worsened outcomes. [2][3][4][5] To improve access to hospital beds, hospitals may increase capacity by either adding beds or by more efficiently using existing beds. Operations management principles have been applied to healthcare to ensure efficient use of beds.…”

mentioning

confidence: 99%

Evolving practice of hospital medicine and its impact on hospital throughput and efficiencies

Chadaga

Maher

Maller³

et al. 2012

Journal of Hospital Medicine

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Hospitalists are uniquely positioned to implement strategies to improve patient flow and efficiency. Hospital leaders have stated they expect hospitalists to comanage surgical patients, participate in observation units, and screen medical admissions, in addition to providing inpatient care for medical patients. We review how the hospitalists' role in acute inpatient care, surgical comanagement, short stay units, chest pain units, and active bed management has improved throughput and patient flow. Journal of Hospital Medicine 2012. © 2012 Society of Hospital Medicine

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The Impact of Emergency Department Crowding Measures on Time to Antibiotics for Patients With Community-Acquired Pneumonia

Cited by 244 publications

References 28 publications

Measuring patient flow in a children's hospital using a scorecard with composite measurement

Measuring patient flow in a children's hospital using a scorecard with composite measurement

Routine Screening for Asymptomatic Abdominal Aortic Aneurysm in High‐risk Patients Is Not Recommended in Emergency Departments That Are Frequently Crowded

Evolving practice of hospital medicine and its impact on hospital throughput and efficiencies

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