A stream for complex, ambulant patients reduces crowding in an emergency department

Abstract

The use of an appropriately resourced stream directed towards seeing a complex group of patients who do not require ongoing nursing care and who are capable of sitting in a chair improved departmental flow.

Two Hour Evaluation and Referral Model for Shorter Turnaround Times in the emergency department

“…While strategies such as clinical streaming, team‐based assessment and early senior consultation have been employed elsewhere, we believe that THERMoSTAT is the first system to refine these elements and combine them with the forcing function of periodic turnover. Cubicles are recycled in a more proactive manner in order to preserve capacity and suppress the development of queues.…”

“…For many departments, this is limited to the development of a ‘fast‐track’ service for low acuity patients, while more sophisticated models typically use ambulatory status or disposition forecasting to allocate streams . A recurring issue is the failure to address the ‘complex ambulant’ cohort that either infiltrates FastTrack or becomes stranded in the waiting room . Rather than create a separate stream, THERMoSTAT recognises that this group requires a similar assessment to ambulance patients and includes them in the Acute stream until disposition is apparent.…”

Impact of the emergency department streaming decision on patients' outcomes

“…The overcrowding of emergency departments (ED) has several serious consequences, including an increase in the waiting times for patients, higher numbers of patients who discharge themselves and increased inpatient (IP) length of stay (LOS) and in‐hospital mortality . ‘Streaming’ occurs in many ED in an effort to reduce crowding and improve the efficiency of care provided to patients while they are in the department . Streaming involves the recognition by ED clinicians of sizeable groups of patients who can be identified quickly and then co‐located in order to receive similar processes of care.…”

“…These groups of patients are sent to discrete areas of the ED where resources are tailored to patients' needs, although limited resource sharing between these areas may carry advantages . The streaming process has proven efficacy when it comes to reducing ED LOS for patients, especially those discharged home . The effect of streaming on those patients who are to be admitted has been less intensively studied.…”

“…[1][2][3] 'Streaming' occurs in many ED in an effort to reduce crowding and improve the efficiency of care provided to patients while they are in the department. 4,5 Streaming involves the recognition by ED clinicians of sizeable groups of patients who can be identified quickly and then co-located in order to receive similar processes of care. A stream might include patients who are older with more complex co-morbidity, who will probably require admission to hospital or who require rapid assessment, investigation and treatment before being discharged home from the ED.…”