Communication and bed reservation: Decreasing the length of stay for emergency department trauma patients

Huang, Derrick; Bastani, Aveh; Anderson, William C.; Crabtree, Janice; Kleiman, S.; Jones, Shanna

doi:10.1016/j.ajem.2018.08.021

Cited by 8 publications

(8 citation statements)

References 35 publications

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“…Fuentes et al instituted a protocol to take patients directly from the CT scanner to the ICU, thus reducing ED LOS by 229 minutes [11]. Huang et al demonstrated a decreased ED LOS for trauma patients by improving communication between the ED and the trauma team [12]. These interventions involved moving trauma patients through the ED without considering the whole ED as a unit.…”

Section: Discussionmentioning

confidence: 99%

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Emergency Department Boarding of Non-Trauma Patients Adversely Affects Trauma Patient Length of Stay

Hymel¹,

Leskovan²,

Thomas³

et al. 2020

Cureus

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Introduction Emergency Department (ED) boarding delays initiation of time-sensitive protocols for trauma patients and makes them susceptible to increased mortality and morbidity. In this study, we compared the ED boarding times of non-trauma patients and ED length of stay (LOS) of trauma patients. Methods This was a single-center retrospective cohort study in a Level 1 trauma center. The median boarding time among non-trauma patients and ED LOS among trauma patients was determined by month between the period of April 2018 to March 2019. Linear regression and Pearson correlation coefficient were used to express the magnitude and direction of the relationship between these two variables. Results During the study period, the mean number of non-trauma patients admitted in our ED per month was 1,154 and trauma patients was 89. The mean of the median boarding time per month for non-trauma patients was 76 minutes, and the mean of the median ED LOS per month for trauma patients was 198 minutes. There was a significant positive correlation between boarding time for non-trauma patients and ED LOS for trauma patients (Pearson correlation coefficient: 0.73; p = 0.007). Conclusion The long boarding times for non-trauma patients is associated with ED LOS for trauma patients, indicating that the total patient volume in the hospital contributes to the trauma patient's stay in the ED. Thus, ED LOS of trauma patients can be minimized by improving overall ED and hospital flow, including non-trauma patients.

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Section: Discussionmentioning

confidence: 99%

“…Consequently, efforts have been made to decrease the boarding time of trauma patients in the ED [5,[11][12]. However, these interventions are focused on expediting the flow of trauma patients from the ED to the ICU and did not involve non-trauma patients in the ED.…”

mentioning

confidence: 99%

Emergency Department Boarding of Non-Trauma Patients Adversely Affects Trauma Patient Length of Stay

Hymel¹,

Leskovan²,

Thomas³

et al. 2020

Cureus

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“…The study concluded that effective interventions link a defined population to appropriate capacity through an efficient process: ineffective interventions were found to have neglected one or more of these three crucial aspects. The model is gaining currency [21][22][23] but has not yet been applied to in-depth analysis of a family of interventions.…”

Section: Conceptual Frameworkmentioning

confidence: 99%

Realist analysis of streaming interventions in emergency departments

Anwar

Rowe

Metge

et al. 2021

leader

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BackgroundSeveral of the many emergency department (ED) interventions intended to address the complex problem of (over)crowding are based on the principle of streaming: directing different groups of patients to different processes of care. Although the theoretical basis of streaming is robust, evidence on the effectiveness of these interventions remains inconclusive.MethodsThis qualitative research, grounded in the population-capacity-process model, sought to determine how, why and under what conditions streaming interventions may be effective. Data came from a broader study exploring patient flow strategies across Western Canada through in-depth interviews with managers at all levels. We undertook realist analysis of interview data from the 98 participants who discussed relevant interventions (fast-track/minor treatment areas, rapid assessment zones, diverse short-stay units), focusing on their explanations of initiatives’ perceived outcomes.ResultsEssential features of streaming interventions included separation of designated populations (population), provision of dedicated space and resources (capacity) and rapid cycle time (process). These features supported key mechanisms of impact: patients wait only for services they need; patient variability is reduced; lag time between steps is eliminated; and provider attitude change promotes prompt discharge. Conversely, reported failures usually involved neglect of one of these dimensions during intervention design and/or implementation. Participants also identified important contextual barriers to success, notably lack of outflow sites and demand outstripping capacity. Nonetheless, failure was more commonly attributed to intervention flaws than to context factors.ConclusionsWhile streaming interventions have the potential to reduce crowding, a theory-based intervention relies on its implementers’ adherence to the theory. Streaming interventions cannot be expected to yield the desired results if operationalised in a manner incongruent with the theory on which they are supposedly based.

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“…Some of them are a mix of OR approaches as noted in He et al [109] and Sir et al [122]. Other papers combine different statistical techniques as evidenced in Fuentes et al [26], Huang et al [110], Techar et al [123], and Ross et al [118]. Another category includes the mix of lean manufacturing and other techniques as exposed in Blick [100], Chadha et al [101], and Furterer [106].…”

Section: Papers Focusing On Reducing the Extended Losmentioning

confidence: 99%

Methodological Approaches to Support Process Improvement in Emergency Departments: A Systematic Review

Ortíz‐Barrios

Alfaro-Saiz

2020

IJERPH

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The most commonly used techniques for addressing each Emergency Department (ED) problem (overcrowding, prolonged waiting time, extended length of stay, excessive patient flow time, and high left-without-being-seen (LWBS) rates) were specified to provide healthcare managers and researchers with a useful framework for effectively solving these operational deficiencies. Finally, we identified the existing research tendencies and highlighted opportunities for future work. We implemented the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology to undertake a review including scholarly articles published between April 1993 and October 2019. The selected papers were categorized considering the leading ED problems and publication year. Two hundred and three (203) papers distributed in 120 journals were found to meet the inclusion criteria. Furthermore, computer simulation and lean manufacturing were concluded to be the most prominent approaches for addressing the leading operational problems in EDs. In future interventions, ED administrators and researchers are widely advised to combine Operations Research (OR) methods, quality-based techniques, and data-driven approaches for upgrading the performance of EDs. On a different tack, more interventions are required for tackling overcrowding and high left-without-being-seen rates.

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Communication and bed reservation: Decreasing the length of stay for emergency department trauma patients

Cited by 8 publications

References 35 publications

Emergency Department Boarding of Non-Trauma Patients Adversely Affects Trauma Patient Length of Stay

Emergency Department Boarding of Non-Trauma Patients Adversely Affects Trauma Patient Length of Stay

Realist analysis of streaming interventions in emergency departments

Methodological Approaches to Support Process Improvement in Emergency Departments: A Systematic Review

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