Alternatives to ward admission from the emergency department

Abstract

There is ever-increasing pressure on hospital resources in general and emergency departments (ED) in particular. At the same time, there is increasing recognition that traditional inpatient ward-based care is not necessary for the majority of children presenting to the ED with acute illness, and that there are patient, family and hospital benefits to pursuing other options. Here, we describe alternative pathways for children presenting to the ED, including short stay and observational medicine, hospital-in-the-home and non-admission enhanced care, in other words, additional management practices or pathways for children who are discharged from the ED. We discuss the principles, models and practical considerations involved in each of these.

A Systematic Review of Criteria-Led Patient Discharge

“…Criteria have been used across the continuum of care, from preadmission to outpatients to postdischarge. 8,9 Bryant and Hopper 8 used criteria to aid decision making prior to a patient's admission, regarding possible alternatives to admission, whereas Turner et al 9 developed criteria based on respiratory outpatient attendances to optimize clinic bookings following discharge. Criteria have even aided the largescale evacuation of patients from hospitals during instances of national emergency.…”

New Zealand’s emergency department target – did it reduce ED length of stay, and if so, how and when?

“…These units, (acute assessment units, observation wards), have been increasingly established and used by hospitals as part of a strategy to manage acute demand [ 45 , 46 ]. The increasing role of SSUs can be justified on clinical and organisational grounds [ 47 , 48 ]. Nevertheless, the existence of these units has the potential to confound ED LOS data, particularly if patients referred to SSUs are taken ‘off the target stream’ [ 31 ].…”

Optimising the service of emergency department in a hospital

“…However, the congestion of the ED is also affected by the resources and operations in other units, particularly for inpatient pathways (Jones et al 2009). Due to the interconnection of the units' operations and patient flow, the decisions made for one unit can significantly affect others regarding patient waiting time and patient departure time (Hall et al 2013;Bryant and Hopper 2016). In the light of the strong interconnection between the ED and other units, the optimal number of finite resources (e.g.…”