scholarly journals 43 Renewing the Frailty Experience: Bringing CGA Into the Emergency Department

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
N Saxton ◽  
D Mayne
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Acute Care ◽  
Early Recognition ◽  
Patient Flow ◽  
Well Being ◽  
Patient Journey ◽  
Frail Patients ◽  
National Priority ◽  
Occupancy Rates

Abstract Topic Early recognition and multidisciplinary management of frail patients in acute care is a national priority. This is reflected in the NHS 10 year plan, NHS Improvement (NHSI) and Getting It Right First Time (GIRFT) ambitions for acute care. The Sunderland Royal Hospital acute frailty service currently reviews frail patients on the Medical Admissions Unit (MAU) each morning. Analysis of our emergency department (ED) data demonstrates that most frail patients arrive to the ED between 12 pm and 18 pm leading to a cohort of frail patients who are not receiving comprehensive geriatric assessment early in their patient journey. Here, we present our piloted expansion of the frailty service into the ED. Intervention Currently the frailty service is provided on MAU between 9 am and 1 pm. The pilot service expansion ran for five weeks between September and October 2018 and involved the acute frailty team being available to ED and MAU from Monday to Friday 0830 am to 1700 pm. Frail patients were proactively identified using the ED patient tracker as well being referred to the team by ED staff. Improvement During the pilot, the team reviewed 131 additional patients. 85% were seen in ED. 61 patients were discharged directly from ED and 33 patients were admitted directly to a back of house medical ward resulting in reduced MAU occupancy rates in the evenings. Concerns that bringing full MDT assessment into ED might result in increased time spent in ED were proven to be unfounded. Median length of stay for admitted patients was low with 49% discharged within 7 days and 9.9% 30 day readmission rate. Feedback from ED and community teams was positive. Discussion It is recognised that early CGA is beneficial for patients with frailty syndromes who are admitted to hospital. Most commonly, this takes place on medical admissions wards. Through this pilot, we have demonstrated significant added benefits of bringing the acute frailty team and crucially CGA into the emergency department setting. As well as increased discharges directly from ED, we demonstrated a reduction in length of stay and readmissions as well as improved patient flow. Our aim is to permanently implement a seven day frailty service with input on MAU as well as ED.

Cognitive Impairment and Length of Stay in Acute Care Hospitals: A Scoping Review of the Literature

2021 ◽  
pp. 1-19
Author(s):  
Jonathan Plante ◽  
Karine Latulippe ◽  
Edeltraut Kröger ◽  
Dominique Giroux ◽  
Martine Marcotte ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Length Of Stay ◽  
Acute Care ◽  
Scoping Review ◽  
Research Question ◽  
Positive Association ◽  
Well Being ◽  
Future Research ◽  
Care Hospital ◽  
The Impact

Abstract Older persons experiencing a longer length of stay (LOS) or delayed discharge (DD) may see a decline in their health and well-being, generating significant costs. This review aimed to identify evidence on the impact of cognitive impairment (CI) on acute care hospital LOS/DD. A scoping review of studies examining the association between CI and LOS/DD was performed. We searched six databases; two reviewers independently screened references until November 2019. A narrative synthesis was used to answer the research question; 58 studies were included of which 33 found a positive association between CI and LOS or DD, 8 studies had mixed results, 3 found an inverse relationship, and 14 showed an indirect link between CI-related syndromes and LOS/DD. Thus, cognitive impairment seemed to be frequently associated with increased LOS/DD. Future research should consider CI together with other risks for LOS/DD and also focus on explaining the association between the two.

scholarly journals The Sydney triage to admission risk tool (START) to improve patient flow in an emergency department: a model of care implementation pilot study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Anja Ebker-White ◽  
Kendall J. Bein ◽  
Saartje Berendsen Russell ◽  
Michael M. Dinh
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Patient Flow ◽  
Intervention Group ◽  
Control Sample ◽  
Patient Admission ◽  
Implementation Study ◽  
Model Of Care ◽  
Early Assessment ◽  
Pilot Implementation

Abstract Background The Sydney Triage to Admission Risk Tool (START) is a validated clinical analytics tool designed to estimate the probability of in-patient admission based on Emergency Department triage characteristics. Methods This was a single centre pilot implementation study using a matched case control sample of patients assessed at ED triage. Patients in the intervention group were identified at triage by the START tool as likely requiring in-patient admission and briefly assessed by an ED Consultant. Bed management were notified of these patients and their likely admitting team based on senior early assessment. Matched controls were identified on the same day of presentation if they were admitted to the same in-patient teams as patients in the intervention group and same START score category. Outcomes were ED length of stay and proportion of patients correctly classified as an in-patient admission by the START tool. Results One hundred and thirteen patients were assessed using the START-based model of care. When compared with matched control patients, this intervention model of care was associated with a significant reduction in ED length of stay [301 min (IQR 225–397) versus 423 min (IQR 297–587) p < 0.001] and proportion of patients meeting 4 h length of stay thresholds increased from 24 to 45% (p < 0.001). Conclusion In this small pilot implementation study, the START tool, when used in conjunction with senior early assessment was associated with a reduction in ED length of stay. Further controlled studies are now underway to further examine its utility across other ED settings.

scholarly journals Emergency Department Patient Flow: The Influence of Hospital Census Variables on Emergency Department Length of Stay

2009 ◽  
Vol 16 (7) ◽  
pp. 597-602 ◽  
Author(s):  
Ray Lucas ◽  
Heather Farley ◽  
Joseph Twanmoh ◽  
Andrej Urumov ◽  
Nils Olsen ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Patient Flow ◽  
Emergency Department Patient

scholarly journals Tracking the patient journey by combining multiple hospital database systems

2014 ◽  
Vol 38 (3) ◽  
pp. 332 ◽  
Author(s):  
Andy Wong ◽  
Erhan Kozan ◽  
Michael Sinnott ◽  
Lyndall Spencer ◽  
Robert Eley
Keyword(s):  
Emergency Department ◽  
Information System ◽  
Information Systems ◽  
Patient Flow ◽  
Database Systems ◽  
Tertiary Hospital ◽  
Patient Data ◽  
Public Hospitals ◽  
Patient Journey ◽  
Corporate Information System

With new national targets for patient flow in public hospitals designed to increase efficiencies in patient care and resource use, better knowledge of events affecting length of stay will support improved bed management and scheduling of procedures. This paper presents a case study involving the integration of material from each of three databases in operation at one tertiary hospital and demonstrates it is possible to follow patient journeys from admission to discharge. What is known about this topic? At present, patient data at one Queensland tertiary hospital are assembled in three information systems: (1) the Hospital Based Corporate Information System (HBCIS), which tracks patients from in-patient admission to discharge; (2) the Emergency Department Information System (EDIS) containing patient data from presentation to departure from the emergency department; and (3) Operation Room Management Information System (ORMIS), which records surgical operations. What does this paper add? This paper describes how a new enquiry tool may be used to link the three hospital information systems for studying the hospital journey through different wards and/or operating theatres for both individual and groups of patients. What are the implications for practitioners? An understanding of the patients’ journeys provides better insight into patient flow and provides the tool for research relating to access block, as well as optimising the use of physical and human resources.

scholarly journals Specialized fast track: a sustainable model to improve emergency department patient flow

2015 ◽  
Vol 4 (5) ◽  
pp. 40
Author(s):  
Emilpaolo Manno ◽  
Marco Pesce ◽  
Umberto Stralla ◽  
Federico Festa ◽  
Silvio Geninatti ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Fast Track ◽  
Patient Flow ◽  
Wait Time ◽  
Emergency Department Patient ◽  
Care Needs ◽  
Time Length ◽  
Hospital Units ◽  
Ed Visits

Objective: Emergency department (ED) overcrowding is a hospital-wide problem that demands a whole-hospital solution. We developed and implemented a fast track model for streaming ED patients with low-acuity illness or injury to specialized care areas (gynecology-obstetrics, orthopedics-trauma, pediatrics, and primary care) staffed by existing specialist resources with access to general ED services. The study aim was to determine whether streaming of ED visits into specialized fast track areas increased operational efficiency and improved patient flow in a mixed adult and pediatric ED without incurring extra costs.Methods: We retrospectively reviewed the ED discharge records of patients who were mainstreamed or fast tracked during the 3-year period from 1 January 2010 through 31 December 2012. ED visits were identified according to a five-level triage scheme; performance indicators were compared for: wait time, length of stay, leave before being seen and revisit rates.Results: A reduction in wait time, length of stay, and leave before being seen rate was seen with fast track streaming (p < .01). These improvements were achieved without additional medical and nurse staffing.Conclusions: Specialized fast track streaming helped us meet patients’ care needs and contain costs. Lower-acuity patients were seen quickly by a specialist and safely discharged or admitted to the hospital without diverting resources from patients with high-acuity illness or injury. Involvement of all stakeholders in seeking a sustainable solution to ED crowding as a hospital-wide problem was key to enhancing cooperation between the ED and the hospital units.

scholarly journals THE EFFECT OF A BOARDING RESTRICTION PROTOCOL ON EMERGENCY DEPARTMENT CROWDING

2021 ◽  
Author(s):  
Ji Hwan Lee ◽  
Ji Hoon Kim ◽  
Incheol Park ◽  
Hyun Sim Lee ◽  
Joon Min Park ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Primary Outcome ◽  
Treatment Time ◽  
Patient Flow ◽  
Hospital Beds ◽  
Before And After ◽  
Day Of The Week ◽  
Ed Crowding ◽  
Post Period

ABSTRACT Background Access block due to a lack of hospital beds causes emergency department (ED) crowding. We initiated the boarding restriction protocol that limits ED length of stay (LOS) for patients awaiting hospitalization to 24 hours from arrival. This study aimed to determine the effect of the protocol on ED crowding. Method This was a pre-post comparative study to compare ED crowding before and after protocol implementation. The primary outcome was the red stage fraction with more than 71 occupying patients in the ED (severe crowding level). LOS in the ED, treatment time and boarding time were compared. Additionally, the pattern of boarding patients staying in the ED according to the day of the week was confirmed. Results Analysis of the number of occupying patients in the ED, measured at 10-minute intervals, indicated a decrease from 65.0 (51.0-79.0) to 55.0 (43.0-65.0) in the pre- and post-periods, respectively (p<0.0001). The red stage fraction decreased from 38.9% to 15.1% of the pre- and post-periods, respectively (p<0.0001). The proportion beyond the goal of this protocol of 24 hours decreased from 7.6% to 4.0% (p<0.0001). The ED LOS of all patients was similar: 238.2 (134.0-465.2) and 238.3 (136.9-451.2) minutes in the pre- and post-periods, respectively. In admitted patients, ED LOS decreased from 770.7 (421.4-1587.1) to 630.2 (398.0-1156.8) minutes (p<0.0001); treatment time increased from 319.6 (198.5-482.8) to 344.7 (213.4-519.5) minutes (p<0.0001); and boarding time decreased from 298.9 (109.5-1149.0) to 204.1 (98.7-545.7) minutes (p<0.0001). In the pre-period, boarding patients accumulated in the ED on weekdays, with the accumulation resolved on Fridays; this pattern was alleviated in the post-period. Conclusions The protocol effectively resolved excessive ED crowding by alleviating the accumulation of boarding patients in the ED on weekdays. Additional studies should be conducted on changes this protocol brings to patient flow hospital-wide.

scholarly journals Length of stay as quality indicator in emergency departments: analysis of determinants in the German Emergency Department Data Registry (AKTIN registry)

2022 ◽  
Author(s):  
Ronny Otto ◽  
Sabine Blaschke ◽  
Wiebke Schirrmeister ◽  
Susanne Drynda ◽  
Felix Walcher ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Emergency Departments ◽  
Patient Flow ◽  
Management Strategies ◽  
Organizational Factors ◽  
Related Factors ◽  
Adult Age ◽  
Emergency Department Data ◽  
Data Registry

AbstractSeveral indicators reflect the quality of care within emergency departments (ED). The length of stay (LOS) of emergency patients represents one of the most important performance measures. Determinants of LOS have not yet been evaluated in large cohorts in Germany. This study analyzed the fixed and influenceable determinants of LOS by evaluating data from the German Emergency Department Data Registry (AKTIN registry). We performed a retrospective evaluation of all adult (age ≥ 18 years) ED patients enrolled in the AKTIN registry for the year 2019. Primary outcome was LOS for the whole cohort; secondary outcomes included LOS stratified by (1) patient-related, (2) organizational-related and (3) structure-related factors. Overall, 304,606 patients from 12 EDs were included. Average LOS for all patients was 3 h 28 min (95% CI 3 h 27 min–3 h 29 min). Regardless of other variables, patients admitted to hospital stayed 64 min longer than non-admitted patients. LOS increased with patients’ age, was shorter for walk-in patients compared to medical referral, and longer for non-trauma presenting complaints. Relevant differences were also found for acuity level, day of the week, and emergency care levels. We identified different factors influencing the duration of LOS in the ED. Total LOS was dependent on patient-related factors (age), disease-related factors (presentation complaint and triage level), and organizational factors (weekday and admitted/non-admitted status). These findings are important for the development of management strategies to optimize patient flow through the ED and thus to prevent overcrowding.

scholarly journals The association between the transfer of emergency department admitted patients to inpatient hallways and outcomes of oncology patients

2015 ◽  
Vol 4 (2) ◽  
pp. 1 ◽  
Author(s):  
Charles Lim ◽  
Matthew C. Cheung ◽  
Maureen E. Trudeau ◽  
Kevin R. Imrie ◽  
Ben De Mendonca ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Patient Flow ◽  
Vital Signs ◽  
Medication Administration ◽  
Oncology Patients ◽  
Flow Quality ◽  
Ed Crowding ◽  
The Impact

Objective: A protocol was implemented to ease Emergency Department (ED) crowding by moving suitable admitted patients into inpatient hallway beds (HALL) or off-service beds (OFF) when beds on an admitting service’s designated ward (ON) were not available. This study assessed the impact of hallway and off-service oncology admissions on ED patient flow, quality of care and patient satisfaction.Methods: Retrospective and prospective data were collected on patients admitted to the medical oncology service from Jan 1 to Dec 31, 2011. Data on clinician assessments and time performance measures were collected. Satisfaction surveys were prospectively administered to all patients. Results: Two hundred and ninty-seven patients (117 HALL, 90 OFF, 90 ON) were included in this study. There were no significant differences between groups for frequency of physician assessments, physical exam maneuvers at initial physician visit, time to complete vital signs or time to medication administration. The median (IQR) time spent admitted in the ED prior to departure from the ED was significantly longer for HALL patients (5.53 hrs [1.59-13.03 hrs]) compared to OFF patients (2.00 hrs [0.37-3.69 hrs]) and ON patients (2.18 hrs [0.15-5.57 hrs]) (p < .01). Similarly, the median (IQR) total ED length of stay was significantly longer for HALL patients (13.82 hrs [7.43-20.72 hrs]) compared to OFF patients (7.18 hrs [5.72-11.42 hrs]) and ON patients (9.34 hrs [5.43-14.06 hrs]) (p < .01). HALL patients gave significantly lower overall satisfaction scores with mean (SD) satisfaction scores for HALL, OFF and ON patients being 3.58 (1.20), 4.23 (0.58) and 4.29 (0.69) respectively (p < .01). Among HALL patients, 58% were not comfortable being transferred into the hallway and 4% discharged themselves against medical advice. Conclusions: The protocol for transferring ED admitted patients to inpatient hallway beds did not reduce ED length of stay for oncology patients. The timeliness and frequency of clinical assessments were not compromised; however, patient satisfaction was decreased.

scholarly journals Associations between hospital deaths (HSMR), readmission and length of stay (LOS): a longitudinal assessment of performance results and facility characteristics of teaching and large-sized hospitals in Canada between 2013–2014 and 2017–2018

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e041648
Author(s):  
Omid Fekri ◽  
Edgar Manukyan ◽  
Niek Klazinga
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Acute Care ◽  
Hospital Performance ◽  
Emergency Department Visits ◽  
Outcome Indicators ◽  
Hospital Deaths ◽  
Resource Intensity ◽  
Performance Results ◽  
Hospital Characteristics

ObjectivesTo examine the association between hospital deaths (hospital standardised mortality ratio, HSMR), readmission, length of stay (LOS) and eight hospital characteristics.DesignLongitudinal observational study.SettingA total of 119 teaching and large-sized hospitals in Canada between fiscal years 2013–2014 and 2017–2018.ParticipantsAnalysis focused on indicator results and characteristics of individual Canadian hospitals.Primary and secondary outcomesHospital deaths (HSMR); all patients readmitted to hospital; average LOS and a series of eight hospital characteristic summary measures: number of acute care hospital stays; number of acute care beds; number of emergency department visits; average acute care resource intensity weight; total acute care resource intensity weight; hospital occupancy rate; patients admitted through the emergency department (%); patient days in alternate level of care (%).ResultsComparing 2013–2014 to 2017–2018, hospital deaths (HSMR) largely declined, while readmissions increased; 69% of hospitals decreased their hospital deaths (HSMR), while 65% of hospitals increased their readmissions rates. A greater proportion of community-large hospitals (31%, n=14) improved on both hospital deaths (HSMR) and readmission compared to Teaching hospitals (13.9%, n=5). Hospital deaths (HSMR), readmission and LOS largely showed very weak and non-significant correlations. LOS was largely positively and statistically significantly correlated with the suite of eight hospital characteristics. Hospital deaths (HSMR) was largely negatively (not statistically significantly) correlated with the hospital characteristics. Readmission was largely not statistically significantly correlated and showed no clear pattern of correlation (direction) with hospital characteristics.ConclusionsExamining publicly reported hospital performance results can reveal meaningful insights into the association among outcome indicators and hospital characteristics. Good or bad hospital performance in one care domain does not necessarily reflect similar performance in other care domains. Thus, caution is warranted in a narrow use of outcome indicators in the design and operationalisation of hospital performance measurement and governance models (namely pay-for-performance schemes). Analysis such as this can also inform quality improvement strategies and targeted efforts to address domains of care experiencing declining performance over time; further granular subdivision of the analyses, for example, by hospital peer-groups, can reveal notable differences in performance.

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