The impact of medical specialist staffing on emergency department patient flow and satisfaction

Linden, Margareta; Beaufort, Roeline A Y de; Meylaerts, S.A.G.; Brand, Crispijn L van den; Linden, Naomi van der

doi:10.1097/mej.0000000000000487

Cited by 12 publications

(15 citation statements)

References 14 publications

(12 reference statements)

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“…Van der Linden et al suggested that additional medical staff during peak hours decreased the need for ancillary diagnostics and shortened the waiting time for contact with the residents or medical specialists. They also demonstrated a positive impact on the ED-LOS and patient satisfaction [ 26 ]. In addition, a prospective study in the Netherlands from Vegting et al concluded that factors which lead to ED stagnation were old age, treatment by more than one speciality during ED stay, and undergoing radiological testing [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Long length of stay at the emergency department is mostly caused by organisational factors outside the influence of the emergency department: A root cause analysis

et al. 2018

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BackgroundEmergency department (ED) crowding is common and associated with increased costs and negative patient outcomes. The aim of this study was to conduct an in-depth analysis to identify the root causes of an ED length of stay (ED-LOS) of more than six hours.MethodsAn observational retrospective record review study was conducted to analyse the causes for ED-LOS of more than six hours during a one-week period in an academic hospital in the Netherlands. Basic administrative data were collected for all visiting patients. A root cause analysis was conducted using the PRISMA-method for patients with an ED-LOS > 6 hours, excluding children and critical care room presentations.Results568 patients visited the ED during the selected week (January 2017). Eighty-four patients (15%) had an ED-LOS > 6 hours and a PRISMA-analysis was performed in 74 (88%) of these patients. 269 root causes were identified, 216 (76%) of which were organisational and 53 (22%) patient or disease related. 207 (94%) of the organisational factors were outside the influence of the ED. Descriptive statistics showed a mean number of 2,5 consultations, 59% hospital admissions or transfers and a mean age of 57 years in the ED-LOS > 6 hours group. For the total group, there was a mean number of 1,9 consultations, 29% hospital admissions or transfers and a mean age of 43 years.ConclusionsThis study showed that the root causes for an increased ED-LOS were mostly organisational and beyond the control of the ED. These results confirm that interventions addressing the complete acute care chain are needed in order to reduce ED-LOS and crowding in ED’s.

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Section: Discussionmentioning

confidence: 99%

Long length of stay at the emergency department is mostly caused by organisational factors outside the influence of the emergency department: A root cause analysis

et al. 2018

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“…It has been shown that presence of consultants at the ED, beside Emergency Physicians, leads to a shorter Length of Stay and higher patient satisfaction. [30]…”

Section: Resultsmentioning

confidence: 99%

Strengths and weaknesses of the acute care systems in the United Kingdom and the Netherlands: what can we learn from each other?

et al. 2019

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Background The demand on Emergency Departments and acute medical services is increasing internationally, creating pressure on health systems and negatively influencing the quality of delivered care. Visible consequences of the increased demand on acute services is crowding and queuing. This manifests as delays in the Emergency Departments, adverse clinical outcomes and poor patient experience. Overview Despite the similarities in the UK’s and Dutch health care systems, such as universal health coverage, there are differences in the number of patients presenting at the Emergency Departments and the burden of crowding between these countries. Given the similarities in funding, this paper explores the similarities and differences in the organisational structure of acute care in the UK and the Netherlands. In the Netherlands, less patients are seen at the ED than in England and the admission rate is higher. GPs and so-called GP-posts serve 24/7 as gatekeepers in acute care, but EDs are heterogeneously organised. In the UK, the acute care system has a number of different access points and the accessibility of GPs seems to be suboptimal. Acute ambulatory care may relieve the pressure from EDs and Acute Medical Units. In both countries the ageing population leads to a changing case mix at the ED with an increased amount of multimorbid patients with polypharmacy, requiring generalistic and multidisciplinary care. Conclusion The acute and emergency care in the Netherlands and the UK face similar challenges. We believe that each system has strengths that the other can learn from. The Netherlands may benefit from an acute ambulatory care system and the UK by optimizing the accessibility of GPs 24/7 and improving signposting for urgent care services. In both countries the changing case mix at the ED needs doctors who are superspecialists instead of subspecialists. Finally, to improve the organisation of health care, doctors need to be visible medical leaders and participate in the organisation of care.

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“…In a pilot study performed in the study setting, a decrease in LOS for admitted patients was found when medical specialists are involved at the ED. In that study, delays in radiology turnaround times were considered a main constraint for ED throughput [28]. This finding led to the organisation of a 5-day Lean project within the radiology department, focusing on improved turnaround time for radiography.…”

Section: Discussionmentioning

confidence: 99%

“…The five attending medical specialists are involved in patients’ assessment on arrival and they perform direct on-site supervision. This change was trialled for 10 weeks in 2016 and showed an overall decrease in LOS with large variability by specialty [28, 29]. The residents kept working as usual.…”

Section: Methodsmentioning

confidence: 99%

“…In radiology, this translates into strategies to reduce wait times [18]. Our Lean team focused on improved radiography and report turnaround time, one of the largest bottlenecks in the ED process according to the attending specialists [28]. The Lean team introduced, amongst other strategies, a diagnostic fast-track for CT, a strategy to reduce back and forth phone calls, and the installation of runners for the transport of patients to and from ED and radiology room.The admission offices’ openings hours were extended from 8 am to 5 pm into from 8 am to 8 pm, to better match the ED peak hours and thus, improve the outflow of the ED.…”

Section: Methodsmentioning

confidence: 99%

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The impact of a multimodal intervention on emergency department crowding and patient flow

Linden

Ufford²,

Linden

2019

Int J Emerg Med

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Objective The objective of this study is to assess the impact of a multimodal intervention on emergency department (ED) crowding and patient flow in a Dutch level 1 trauma center. Methods In this cross-sectional study, we compare ED crowding and patient flow between a 9-month pre-intervention period and a 9-month intervention period, during peak hours and overall (24/7). The multimodal intervention included (1) adding an emergency nurse practitioner (ENP) and (2) five medical specialists during peak hours to the 24/7 available emergency physicians (EPs), (3) a Lean programme to improve radiology turnaround times, and (4) extending the admission offices’ openings hours. Crowding is measured with the modified National ED OverCrowding Score (mNEDOCS). Furthermore, radiology turnaround times, patients’ length of stay (LOS), proportion of patients leaving without being seen (LWBS) by a medical provider, and unscheduled representations are assessed. Results The number of ED visits were grossly similar in the two periods during peak hours (15,558 ED visits in the pre-intervention period and 15,550 in the intervention period) and overall (31,891 ED visits in the pre-intervention period vs. 32,121 in the intervention period). During peak hours, ED crowding fell from 18.6% (pre-intervention period) to 3.5% (intervention period), radiology turnaround times decreased from an average of 91 min (interquartile range 45–256 min) to 50 min (IQR 30–106 min., p < 0.001) and LOS reduced with 13 min per patient from 167 to 154 min ( p < 0.001). For surgery, neurology and cardiology patients, LOS reduced significantly (with 17 min, 25 min, and 8 min. respectively), while not changing for internal medicine patients. Overall, crowding, radiology turnaround times and LOS also decreased. Less patients LWBS in the intervention period (270 patients vs. 348 patients, p < 0.001) and less patients represented unscheduled within 1 week after the initial ED visit: 864 (2.7%) in the pre-intervention period vs. 645 (2.0%) patients in the intervention period, p < 0.001. Conclusions In this hospital, a multimodal intervention successfully reduces crowding, radiology turnaround times, patients’ LOS, number of patients LWBS and the number of unscheduled return visits, suggesting improved ED processes. Further research is required on total costs of care and long-term effects.

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The impact of medical specialist staffing on emergency department patient flow and satisfaction

Cited by 12 publications

References 14 publications

Long length of stay at the emergency department is mostly caused by organisational factors outside the influence of the emergency department: A root cause analysis

Long length of stay at the emergency department is mostly caused by organisational factors outside the influence of the emergency department: A root cause analysis

Strengths and weaknesses of the acute care systems in the United Kingdom and the Netherlands: what can we learn from each other?

The impact of a multimodal intervention on emergency department crowding and patient flow

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