Time Series Analysis of Variables Associated With Daily Mean Emergency Department Length of Stay

Rathlev, Niels K.; Chessare, John B.; Olshaker, Jonathan S.; Obendorfer, D.; Mehta, Supriya D.; Rothenhaus, Todd; Crespo, Steven; Magauran, Brendan; Davidson, Kathy K.; Shemin, Richard J.; Lewis, Keith P.; Becker, James M.; Fisher, Linda; Guy, Linda; Cooper, A.R.; Litvak, Eugene

doi:10.1016/j.annemergmed.2006.11.007

Cited by 184 publications

(126 citation statements)

References 15 publications

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“…Demand factors include patient volume, complexity, care needs, expectations, boarding levels, and arrival patterns, including predictable and unpredictable surges. [14][15][16][17] Capacity factors include number and type of ED care spaces; the proportion of these lost to inpatient boarding; the adequacy of clinician staffing, including degree to which physician, nurse, and ancillary provider availability is matched to patient inflow; the presence and level of house staff support; ED technical infrastructure; consultant responsiveness; lab and imaging turnaround times; and other factors. ED performance is also influenced by process efficiencies in registration and triage, front-end intake models, nurseinitiated diagnostics, information technology system ergonomics, bed turnover strategies, departmental culture, and other factors.…”

Section: Discussionmentioning

confidence: 99%

Impact of physician payment mechanism on emergency department operational performance

Innes

Scheuermeyer

Marsden

et al. 2018

CJEM

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CLINICIAN'S CAPSULEWhat is known about the topic? Fee-for-service compensation may motivate physicians to see more patients and improve throughput, or drive excessive testing and referral behaviour that undermine emergency performance. What did this study ask? Does fee-for-service payment reduce emergency wait times, length of stay, and left without being seen rates? What did this study find? We observed an unsustained 24% reduction in time to physician, but no change in length of stay or left without being seen rates. Why does this study matter to clinicians? Fee-for-service compensation may have transient motivational effect but is unlikely to generate system-level improvement. ABSTRACTObjective: Fee-for-service payment may motivate physicians to see more patients and achieve higher productivity. In 2015, emergency physicians at one Vancouver hospital switched to fee-for-service payment, while those at a sister hospital remained on contract, creating a natural experiment where the compensation method changed, but other factors remained constant. Our hypothesis was that fee-for-service payment would increase physician efficiency and reduce patient wait times. Methods: This interrupted time series with concurrent control analysed emergency department (ED) performance during a 42-week period, encompassing the intervention (fee for service). Data were aggregated by week and plotted in a time series fashion. We adjusted for autocorrelation and developed general linear regression models to assess level and trend changes. Our primary outcome was the wait time to physician. Results: Data from 142,361 ED visits were analysed. Baseline wait times rose at both sites during the pre-intervention phase.Immediately post-intervention, the median wait time increased by 2.4 minutes at the control site and fell by 7.2 minutes at the intervention site (difference = 9.6 minutes; 95% confidence interval, 2.9-16.4; p = 0.007). The wait time trend (slope) subsequently deteriorated by 0.5 minutes per week at the intervention site relative to the expected counterfactual (p for the trend difference = 0.07). By the end of the study, cross-site differences had not changed significantly from baseline. Conclusion: Fee-for-service payment was associated with a 9.6-minute (24%) reduction in wait time, compatible with an extrinsic motivational effect; however, this was not sustained, and the intervention had no impact on other operational parameters studied. Physician compensation is an important policy issue but may not be a primary determinant of ED operational efficiency. RÉSUMÉObjectif: Le mode de paiement à l'acte peut inciter les médecins à voir plus de patients et ainsi à accroître la productivité. En 2015, des urgentologues travaillant dans un hôpital de Vancouver sont passés au mode de paiement à l'acte, tandis que d'autres travaillant dans un hôpital de type et de grosseur comparables ont conservé le mode de paiement contractuel, ce qui a permis de mener une expérience naturelle dans laquelle seuls les modes de rémunération avaient c...

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Section: Discussionmentioning

confidence: 99%

Impact of physician payment mechanism on emergency department operational performance

Innes

Scheuermeyer

Marsden

et al. 2018

CJEM

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“…Rathlev et al found that imbalanced surgical schedules had a link with decreases in throughput, and this was corroborated with the qualitative data. [26] With the number of surgeries requiring hospitalization growing in the participating hospitals, imbalanced surgery schedules become more and more of a factor in causing ED boarding.…”

Section: Imbalance In Surgical Schedulingmentioning

confidence: 99%

Emergency boarding: An integrative framework for analyzing causes and seeking solutions

Limoges

Gemmel

Landry

et al. 2017

JHA

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Background: One of the root causes of crowding at the Emergency Department (ED) is boarding, i.e. the practice of holding admitted patients in the ED until an inpatient (IP) bed becomes available. Although ED boarding has been approached by various authors, few of them have aimed to see how different hospitals perform in regard to this issue. Objective: This study will approach ED boarding from different angles, analyzing both quantitative and qualitative data, and following both deductive and inductive reasoning. The purpose is to develop a validated integrative conceptual framework which can be used to analyze ED boarding, and to look for solutions. Methods: The development of the framework is based on an extensive literature review and a multiple case study research with both qualitative and quantitative data collection. Results: ED boarding was found to be prominent in the studied hospitals. Four root causes of ED boarding were elucidated, which are: (1) uncoordinated admissions and discharges, (2) late discharges, (3) the inability to discharge patients, and (4) a lack of communication, collaboration, and information between the different actors of the patient care process. Many solutions are proposed to improve these issues. Conclusions: Through the analysis of various types of data, an integrative conceptual framework for ED boarding was elaborated for analyzing causes and seeking solutions. The quantative data cannot only be used in the analysis stage, but can also help in designing a solution as there are clear recognizable trends in arrival, discharge and ED boarding time. "Communication, collaboration and information", although not explicitly discussed in the literature, was found to be the most prominent cause and solution to ED boarding in the field study. Practice implications: Management practitioners now have a framework demonstrating probable causes for ED boarding, which provides a starting point for analysis within their establishments. Pathways to improvement are suggested as well, which will help managers to reduce ED boarding. Communication, collaboration and information are important in these improvement efforts.

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“…Other studies suggest that topmanagement-led mergers and radical organizational changes in healthcare are difficult and complex and that they often result in unforeseen disruption in services 4 as well as hospital overcrowding. 5 Overcrowding has in turn been shown to cause negative impacts on Emergency Department throughput [6][7][8][9] and decreased mental health in medical personnel. 10 It has also been shown to cause adverse patient outcomes through delayed treatment.…”

Section: Introductionmentioning

confidence: 99%

Attending physicians believe that hospitalized patients are treated at the appropriate level of care: A qualitative study

Mauritzon

Blom

Borna

et al. 2016

International Journal of Healthcare Management

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The purpose of this paper is to investigate the appropriateness of hospitalized patients' level of care as assessed by their treating physicians. The study was conducted as a qualitative study, based on a questionnaire. The study suggests that physicians generally believe that patients who occupy in-hospital beds are cared for at the appropriate level of care. It is worth to note that a relatively large fraction of patients have had their medical needs attended to, but remain hospitalized while waiting for municipal action. Successful downsizing of in-hospital bed-capacity assumes that either a segment of patients who are inappropriately hospitalized exists and could be identified, or that viable alternatives to in-hospital care exist and are available. The results of the present study argue against the first statement. However, we have identified a segment of patients who experience an unnecessarily long in-patient length of stay due to waiting times for municipal action and other post-discharge follow-up measures. Alternatives to in-hospital care which deserve further attention are supporting services in the outpatient setting.

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Time Series Analysis of Variables Associated With Daily Mean Emergency Department Length of Stay

Cited by 184 publications

References 15 publications

Impact of physician payment mechanism on emergency department operational performance

Impact of physician payment mechanism on emergency department operational performance

Emergency boarding: An integrative framework for analyzing causes and seeking solutions

Attending physicians believe that hospitalized patients are treated at the appropriate level of care: A qualitative study

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