scholarly journals LO67: A variation on Triage Liaison Physicians (TLP): a comparative analysis of the Emergency Department Disposition and Care Consultant (EDC) concept

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S30-S30
Author(s):  
B. H. Rowe ◽  
A. Haponiuk ◽  
J. Lowes ◽  
W. Sevcik ◽  
C. Villa-Roel ◽  
...  
Keyword(s):  
Emergency Department ◽  
Tertiary Care ◽  
Pilot Project ◽  
Chi Square ◽  
Left Without Being Seen ◽  
Ed Overcrowding ◽  
Discharged Patients ◽  
Level 3 ◽  
Dichotomous Outcomes ◽  
And Control

Introduction: Despite evidence that triage liaison physicians (TLP) effectively reduce emergency department (ED) overcrowding, support for these interventions is patchy. The aim of this study was to evaluate the implementation of a TLP-like ED Disposition and Care Consultant (EDC) shift at an academic tertiary care ED. Methods: A 24-week pilot project was conducted 11/16-04/17. Physicians worked 8- hour day (07-15:00) and/or evening (15:00-23:00) EDC shifts and performed immediate triage and patient care when needed, assisted triage RNs, answered all incoming calls, and managed administrative matters. Due to their voluntary nature, not all shifts were filled. This study compared active (EDC) and control (C) shifts on the following ED metrics: length of stay (LOS), proportions of patients who left without being seen (LWBS), and safety (return visits to ED). Descriptive (median and interquartile range {IQR} and proportions) and simple (Wilcoxson-Mann-Whitney, chi-square, z-proportion) tests are presented for continuous and dichotomous outcomes, respectively. Multiple linear regression identified factors associated with LOS. Results: Of 112 possible EDC shifts, 58 (52%) were filled involving 4289 patients and compared to 276 C shifts involving 21,358 patients. ED volume, patient age (49; IQR: 31, 66), mode of arrival (~30% EMS), triage levels (~51% level 3), and complaints were similar between the groups. Overall, the EDC group reduced LWBS by 16% (8.7% vs. 10.4%; p=0.001), ED LOS for discharged patients by 30 minutes (5.5 vs. 6.0 hours; p<0.001), and ED LOS for admitted patients by 42 minutes (9.7 vs. 10.4 hours; p=0.02). The EDC increased the proportion discharged <4 hours by 28% (20.1 vs. 15.7%; p<0.001) and increased the proportion admitted <8 hours by 17% (8.2% vs. 9.6%, p=0.002). ED relapses <72 hours were similar (9.3% vs. 8.9%; p=0.4); however, admissions were higher in the EDC shifts (25.3% vs. 23.8%; p=0.04). In addition to EDC coverage status, LOS was influenced by triage level (1.7%, p<0.001), disposition (19.6%, p<0.001), and age (4.8%, p<0.001). Conclusion: Our results indicate that an EDC shift, while unpopular with many physicians, provides valuable services to an overcrowded ED and that the implementation of this type of shift could reduce LOS and LWBS statistics in a tertiary care institution. Additional evaluations to examine this and other front-end interventions in other ED centers are indicated.

scholarly journals An Assessment of Emergency Department Throughput and Provider Satisfaction after the Implementation of a Scribe Program

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Brandon Allen ◽  
Ben Banapoor ◽  
Emily C. Weeks ◽  
Thomas Payton
Keyword(s):  
Emergency Department ◽  
Program Implementation ◽  
Tertiary Care ◽  
Care Facility ◽  
Workplace Satisfaction ◽  
Electronic Survey ◽  
Left Without Being Seen ◽  
Tertiary Care Facility ◽  
Discharged Patients ◽  
The Impact

Objectives. To assess the impact of a scribe program on an academic, tertiary care facility. Methods. A retrospective analysis of emergency department (ED) data, prior to and after scribe program implementation, was used to quantitatively assess the impact of the scribe program on measures of ED throughput. An electronic survey was distributed to all emergency medicine residents and advanced practice providers to qualitatively assess the impact of the scribe program on providers. Results. Several throughput time measures were significantly lower in the postscribe group, compared to prescribe implementation, including time to disposition. The left without being seen (LWBS) decrease was not statistically significant. A total of 30 providers responded to the survey. 100% of providers indicated scribes are a valuable addition to the department and they enjoy working with scribes. 90% of providers indicated scribes increase their workplace satisfaction and quality of life. Conclusions. Through evaluation of prescribe and postscribe implementation, the postscribe time period reflects many throughput improvements not present before scribes began. Scribe Program implementation led to improved ED throughput for discharged patients with further system-wide challenges needing to be addressed for admitted patients.

scholarly journals The effect of a zero-diversion policy on emergency department performance measures

2013 ◽  
Vol 2 (4) ◽  
pp. 144
Author(s):  
Eman Spaulding ◽  
Laurie Byrne ◽  
Eric Armbrecht ◽  
Collin Jackson ◽  
Preeti Dalawari
Keyword(s):  
Emergency Department ◽  
Performance Measures ◽  
Care Center ◽  
Tertiary Care ◽  
Admission Rate ◽  
Medical Advice ◽  
Hospital Admission Rate ◽  
Left Without Being Seen ◽  
Before And After ◽  
Discharged Patients

This study examines how emergency department (ED) performance measures at an academic tertiary care center in the Midwest were affected by a regionally-adopted zero diversion policy. Two six-month periods before and after the policy was enacted were selected to measure differences in key performance measures, including left without treatment (LWOT), left without being seen (LWBS), left against medical advice (AMA), mortality, length of stay and hospital admission rate. Total ED census during the two periods was similar. While the zero diversion policy was in effect, LWOT and LWBS rates were 19.4% and 18.2% lower, respectively, than the prior period, p < .002; discharged patients had faster treatment times (228 + 8.0 minutes vs. 242 + 9.0 minutes), p = .015. No differences were observed in AMA or mortality rates. This study revealed no worsening of ED performance measures after adoption of a zero diversion policy. 

Abstract 14721: Impact of Covid-19 on Cardiology Consultation in Tertiary Care Hospital of a Developing Country

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
ghufran adnan ◽  
Osman Faheem ◽  
Maria Khan ◽  
Pirbhat Shams ◽  
Jamshed Ali
Keyword(s):  
Emergency Department ◽  
Tertiary Care ◽  
Reduction Rate ◽  
Care Hospital ◽  
Chi Square ◽  
Coronary Syndrome ◽  
Significant Difference ◽  
Drastic Increase ◽  
Chi Square Test ◽  
The Difference

Introduction: COVID-19 pandemic has overwhelmed the healthcare system of Pakistan. There has been observation regarding changes in pattern of patient presentation to emergency department (ED) for all diseases particularly cardiovascular. The aim of the study is to investigate these changes in cardiology consultations and compare pre-COVID-19 and COVID-19 era. Hypothesis: There is a significant difference in cardiology consultations during COVID era as compared to non-COVID era. Method: We collected data retrospectively of consecutive patients who visited emergency department (ED) during March-April 2019 (non-COVID era) and March-April 2020 (COVID era). Comparison has been made to quantify the differences in clinical characteristics, locality, admission, type, number, and reason of Cardiology consults generated. Results: We calculated the difference of 1351 patients between COVID and non-COVID era in terms of cardiology consults generated from Emergency department, using Chi-square test. Out of which 880 (59%) are male with mean age of 61(SD=15). Analysis shows pronounced augmentation in number of comorbidities [Hypertension(6%), Chronic kidney disease (6%), Diabetes (5%)] but there was 36% drop in total cardiology consultations and 43% reduction rate in patient’s ED visit from other cities during COVID era. There was 60% decrease in acute coronary syndrome presentation in COVID era, but fortuitously drastic increase (30%) in type II myocardial injury has been noted. Conclusion: There is a remarkable decline observed in patients presenting with cardiac manifestations during COVID era. Lack in timely care could have a pernicious impact on outcomes, global health care organizations should issue directions to adopt telemedicine services in underprivileged areas to provide timely care to cardiac patients.

scholarly journals MP58: Have opioid prescription by emergency physicians changed significantly over five years?

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S63-S63
Author(s):  
M. Wei ◽  
M. Da Silva ◽  
J. Perry
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Tertiary Care ◽  
Opioid Analgesia ◽  
Emergency Physicians ◽  
Prescribing Practices ◽  
Chi Square ◽  
Opioid Prescription ◽  
Emergency Department Care ◽  
Undetermined Etiology

Introduction: It is believed by some that emergency physicians prescribe more opioids than required to manage patients’ pain, and this may contribute to opioid misuse. The objective of our study was to assess if there has been a change in opioid prescribing practices by emergency physicians over time for undifferentiated abdominal pain. Methods: A medical record review for adult patients presenting at two urban academic tertiary care emergency departments was conducted for two distinct time periods; the years of 2012 and 2017. The first 500 patients within each time period with a discharge diagnosis of “abdominal pain” or “abdominal pain not yet diagnosed” were included. Data were collected regarding analgesia received in the emergency department and opioid prescriptions written. Opioids were standardized into morphine equivalent doses to compare quantities of opioids prescribed. Analyses included t-test for continuous and chi-square for categorical data. Results: 1,000 patients were included in our study. The mean age was 42.0 years and 69.6% of patients were female. Comparing 2017 to 2012, there was a non-significant decrease in opioid prescriptions written for patients discharged directly by emergency physicians, from 17.8% to 14.4% (p = 0.14). Mean opioid quantities per prescription decreased from 130.4 milligrams of morphine equivalents per prescription to 98.9 milligrams per prescription (p = 0.002). 13.9% of opioid prescriptions in 2017 were for more than 3 days, which is a decrease from 28.1% in 2012. During the emergency department care, there was an increase in foundational analgesia use prior to initiating opioids from 17.6% to 26.8% (p = 0.001). There was also a decrease for within ED opioid analgesia use from 40.0% to 32.8% (p = 0.018). Conclusion: Opioid prescription rates did not change significantly during our study. However, physicians reduced the quantity of opioids per prescription and used less opioid analgesia in the emergency department for abdominal pain of undetermined etiology.

scholarly journals Changes in Emergency Department Performance during Strike of Junior Physicians in Korea

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Jeongyong Sim ◽  
Yuri Choi ◽  
Jinwoo Jeong
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Tertiary Care ◽  
Control Period ◽  
Junior Doctors ◽  
And Performance ◽  
Almost All ◽  
Ed Operations ◽  
And Control

Objective. A nationwide strike that took place from August 21 to September 7, 2020, which was led by young doctors represented by residents and interns, resulted in shortages of manpower at almost all university and training hospitals. This study aimed to identify differences in the process and outcomes of emergency department (ED) patient care by comparing the performance over about 2 weeks of the strike with that during the usual ED operations. Methods. This retrospective observational study evaluated ED flow and performance during the junior doctors’ strike and compared it with the usual period in a single tertiary-care academic hospital. The outcome variables were defined as ED length of stay, crude mortality, and hospital mortality and adjusted for demographic and clinical parameters. The effect of the doctors’ strike on hospital mortality adjusted for demographic and clinical variables was investigated using logistic regression. Results. A total of 1,121 and 1,496 patients visited the ED during the strike and control periods (both 17 days), respectively. The care usually provided by four or six physicians, including one specialist, was replaced with that by one or two specialists at any one time. During the trainee doctors’ strike, EM specialists managed patients with fewer consultations. However, the proportion of patients who underwent laboratory and radiologic tests did not change significantly. The median ED length of stay significantly decreased from 359 minutes (interquartile range, IQR: 147–391) in the control period to 326 minutes (IQR: 123–318) during the strike period P < 0.001 . The doctors’ strike was not found to have a significant effect on mortality after adjustments with other variables. Conclusion. During the junior doctors’ strike in 2020 in Korea, EM specialists efficiently managed the care of emergency patients with higher levels of acuity without compromising the survival rate, through fewer consultations and faster disposition.

scholarly journals P009: Emergency department overcrowding associated with increased door-to-ecg time in patients with chest pain

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S60-S60
Author(s):  
M. Bhatia ◽  
W. Hopman ◽  
C. Mckaigney ◽  
D. Loricchio ◽  
A. K. Hall
Keyword(s):  
Emergency Department ◽  
Chest Pain ◽  
Tertiary Care ◽  
Positive Association ◽  
Additional Patient ◽  
Negative Consequences ◽  
Linear Regression Models ◽  
Significant Positive Association ◽  
Ed Overcrowding ◽  
Age And Sex

Introduction: Emergency Department (ED) overcrowding has been shown to delay time sensitive tests and therapies. North American guidelines call for Door-to ECG (DTE) times to be <10min in patients presenting with chest pain as delays have been shown to lead to poorer patient outcomes. We hypothesize that increased ED crowding will increase the DTE times. Methods: This was a retrospective cohort study from July 2015-May 2016 at a single tertiary care Canadian ED (53000 visits per year). Data were extracted from the ED information system (EDIS) which contains an organized record of ED activity for each visit. Our selection criteria screened for patients presenting with complaints that included chest pain, chest heaviness, chest tightness and chest burning. The primary outcome of the study was the association between ED occupancy and DTE time, which was measured using a non-parametric Spearman correlation. Multivariable linear regression models controlling for age and sex were developed for both time in minutes, and the log transformed time in minutes. Results: There were 2479 ECGs done on patients presenting with chest pain that met inclusion criteria. The median DTE time was 55.1 minutes. There was a significant positive association between DTE time and ED occupancy (rho=.133, p<0.001). DTE time increased by 0.64 minutes (or approximately 0.4%) for each additional patient in the ED, p<0.001. Additionally, younger age and female sex were also associated with increased DTE time. Conclusion: Increased ED occupancy was correlated with longer DTE times at a single Canadian ED, even after controlling for age and sex. This study provides an example of the negative consequences of ED overcrowding.

scholarly journals Trends in use in a Canadian pediatric emergency department

CJEM ◽  
2014 ◽  
Vol 16 (05) ◽  
pp. 405-410 ◽  
Author(s):  
Quynh Doan ◽  
Emerson D. Genuis ◽  
Alvis Yu
Keyword(s):  
Emergency Department ◽  
Patient Outcomes ◽  
Primary Outcome ◽  
Tertiary Care ◽  
Pediatric Emergency ◽  
Pediatric Emergency Department ◽  
Ed Overcrowding ◽  
Secondary Outcomes ◽  
Ed Crowding

ABSTRACTIntroduction:Emergency department (ED) crowding is a significant problem in Canada and has been associated with decreased quality of care in general and pediatric emergency departments (PEDs). Although boarding of admitted patients in the ED is the main contributor to adult ED overcrowding, factors involved in PED crowding may be different. The objective of this study was to report the trend in PED services use and to document the degree of overcrowding experienced in a Canadian PED.Methods:A retrospective cohort study was conducted using administrative data from a tertiary care PED from 2002 to 2011. The primary outcome was PED use (total volume of visits and case severity per triage levels using the Canadian Triage and Acuity Scale [CTAS] score and admissions). Secondary outcomes included measures of PED overcrowding, such as rates of patients leaving without being seen (LWBS) and length of stay (LOS).Results:Total volumes increased by 30% over the 10-year study period, whereas hospitalizations remained stable at approximately 10%. Trends in CTAS levels did not indicate meaningful changes in the severity of cases treated at our PED. LWBS proportions among CTAS 3, CTAS 4, and CTAS 5 groups and LOS for all CTAS groups progressively and statistically increased from year to year.Conclusions:Over the course of the study period, there was a substantial increase in PED visits,which likely contributed to the worsening markers of PED flow outcomes. Further study into the effects of PED crowding on patient outcomes is warranted.

scholarly journals P121: Understanding health equity: a pilot project to collect socio-demographic information on emergency department patients at registration

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S119
Author(s):  
S. Vaillancourt ◽  
M. McGowan ◽  
C. Semprun ◽  
P. Hannam ◽  
G. Bandiera ◽  
...  
Keyword(s):  
Emergency Department ◽  
Data Collection ◽  
Large Scale ◽  
Capture Rate ◽  
Tertiary Care ◽  
Participation Rate ◽  
Pilot Project ◽  
Patient Data ◽  
Structured Interviews ◽  
Number Of Patients

Introduction: There is strong evidence that socio-economic factors such as income, housing and ethnicity are linked to health outcome disparities for emergency department (ED) patients. However, lack of real-time patient data has limited our ability to identify, understand and address health disparities. During a 14-week period, we assessed the feasibility and acceptability of the systematic collection of patient-level equity data in a busy tertiary care urban ED. Methods: We assessed feasibility by directly observing impact on registration time, percentage of patients on which data was collected, and ambulance patient data collection. We also assessed acceptability to patients, registration staff and clinicians through structured interviews of patients systematically sampled, focus group and surveys of registration staff and survey of clinicians. Results: Over the course of the study, equity data was collected on 2017 patients. Capture rate peaked in week 7 with 51% of eligible patients offered the equity questions and 30% answering. Average patient registration time increased from 215 seconds to 345 seconds (60%). Data collection with ambulance patients did not appear feasible. Patients (n=30) reported being comfortable with most questions except income (47% comfortable). 93% believed it could improve health services. However, a small number of patients voiced concern that the data could result in discrimination. Registration staff required sustained support and engagement, but some continued to feel uncomfortable with offering the questionnaire to some patients. Conclusion: Large scale collection of equity data is feasible but requires additional resources and sustained staff and patient support. Patient participation rate is likely to remain relatively low and is likely to underestimate disadvantaged groups. Data collection at multiple points within an institution may improve capture rate.

scholarly journals Impact of Delayed Admission to the Intensive Care Unit from the Emergency Department upon Sepsis Outcomes and Sepsis Protocol Compliance

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Michael Agustin ◽  
Lori Lyn Price ◽  
Augustine Andoh-Duku ◽  
Peter LaCamera
Keyword(s):  
Emergency Department ◽  
Hospital Mortality ◽  
Statistical Significance ◽  
Tertiary Care ◽  
Included Study ◽  
Chi Square ◽  
Significant Difference ◽  
Protocol Compliance ◽  
Sepsis And Septic Shock ◽  
The Impact

Rationale. The impact of emergency department length of stay (EDLOS) upon sepsis outcomes needs clarification. We sought to better understand the relationship between EDLOS and both outcomes and protocol compliance in sepsis. Methods. We performed a retrospective observational study of septic patients admitted to the ICU from the ED between January 2012 and December 2015 in a single tertiary care teaching hospital. 287 patients with severe sepsis and septic shock were included. Study population was divided into patients with EDLOS < 6 hrs (early admission) versus ≥6 hours (delayed admission). We assessed the impact of EDLOS on hospital mortality, compliance with sepsis protocol, and resuscitation. Statistical significance was determined by chi-square test. Results. Of the 287 septic ED patients, 137 (47%) were admitted to the ICU in <6 hours. There was no significant in-hospital mortality difference between early and delayed admissions (p=0.68). Both groups have similar compliance with the 3-hour protocol (p=0.77). There was no significant difference in achieving optimal resuscitation within 12 hours (p=0.35). Conclusion. We found that clinical outcomes were not significantly different between early and delayed ICU admissions. Additionally, EDLOS did not impact compliance with the sepsis protocol with the exception of repeat lactate draw.

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