Full capacity protocol: an end to double standards in acute hospital care provision

Gilligan, Peadar; Quin, Gareth

doi:10.1136/emj.2009.088690

Cited by 5 publications

(8 citation statements)

References 35 publications

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“…Recent work suggests that ED overcrowding compromises timeliness of resuscitative care, with potentially devastating effects to individual patients [8], and that ED overcrowding might have increased in magnitude over time [9]. Strategies to reduce overcrowding have been proposed [2,10-15] but their extent of implementation is variable [4,14,16]. …”

Section: Introductionmentioning

confidence: 99%

“…Boarding is, in turn, caused by scarcity of inpatient beds [1,2,14,16,17]. Some consider ED overcrowding a symptom of the broader dysfunction in the healthcare system, rather than a problem residing solely in the ED [20-22].…”

Section: Introductionmentioning

confidence: 99%

“…Some consider ED overcrowding a symptom of the broader dysfunction in the healthcare system, rather than a problem residing solely in the ED [20-22]. Although not thoroughly investigated, full capacity protocols and other solutions aiming at distributing workload throughout the hospital instead of accumulating patients in the ED appear promising [16,23]. When asked, patients prefer boarding in inpatient hallways to ED hallways [24].…”

Section: Introductionmentioning

confidence: 99%

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The probability of patients being admitted from the emergency department is negatively correlated to in-hospital bed occupancy – a registry study

et al. 2014

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BackgroundThe association between emergency department (ED) overcrowding and poor patient outcomes is well described, with recent work suggesting that the phenomenon causes delays in time-sensitive interventions, such as resuscitation. Even though most researchers agree on the fact that admitted patients boarding in the ED is a major contributing factor to ED overcrowding, little work explicitly addresses whether in-hospital occupancy is associated to the probability of patients being admitted from the ED. The objective of the present study is to investigate whether such an association exists.MethodsRetrospective analysis of data on all ED visits to Helsingborg General Hospital in southern Sweden between January 1, 2011, and December 31, 2012, was undertaken. The fraction of admitted patients was calculated separately for strata of in-hospital occupancy <95%, 95–100%, 100–105%, and >105%. Multivariate models were constructed in an attempt to take confounding factors, e.g., presenting complaints, age, referral status, triage priority, and sex into account. Subgroup analysis was performed for each specialty unit within the ED.ResultsOverall, 118,668 visits were included. The total admitted fraction was 30.9%. For levels of in-hospital occupancy <95%, 95–100%, 100–105%, and >105% the admitted fractions were 31.5%, 30.9%, 29.9%, and 28.7%, respectively. After taking confounding factors into account, the odds ratio for admission were 0.88 (CI 0.84–0.93, P >0.001) for occupancy level 95–100%, 0.82 (CI 0.78–0.87, P >0.001) for occupancy level 100–105%, and 0.74 (CI 0.67–0.81, P >0.001) for occupancy level >105%, relative to the odds ratio for admission at occupancy level <95%. A similar pattern was observed upon subgroup analysis.ConclusionsIn-hospital occupancy was significantly associated with a decreased odds ratio for admission in the study population. One interpretation is that patients who would benefit from inpatient care instead received suboptimal care in outpatient settings at times of high in-hospital occupancy. A second interpretation is that physicians admit patients who could be managed safely in the outpatient setting, in times of good in-hospital bed availability. Physicians thereby expose patients to healthcare-associated infections and other hazards, in addition to consuming resources better needed by others.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The probability of patients being admitted from the emergency department is negatively correlated to in-hospital bed occupancy – a registry study

et al. 2014

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“…(p17) Since 2005, Lean has been used tactically for discrete, departmental problems in hospitals. 9 Lean techniques have been used to improve the performance of hospital administration, specialty clinics in dermatology and gastroenterology, health plans and medical practices 10 ; heart and vascular centers 2 ; oncology clinics 11 ; radiology 12 ; emergency departments [13][14][15][16][17][18] ; and entire hospital systems. 3 Increasingly, Lean has been used as a system-wide operating framework within health care systems that have emerged as early adopters in the diffusion of Lean as a major innovation in health care.…”

mentioning

confidence: 99%

From Toyota to the Bedside

Johnson

Smith

Mastro

2012

Nursing Administration Quarterly

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The advent of health care reform means new pressures on American hospitals, which will be forced to do more with less. In the next decade, increased use of "Lean" principles and practices in hospitals can create real value by reducing waste and improving productivity, costs, quality, and the timely delivery of patient care services. In 2010, the Institute of Medicine recommended that nurses lead collaborative quality improvement efforts and assume a major role in redesigning health care in the United States. In this article, we provide an overview of the use of Lean techniques in health care and 2 case studies of successful, nurse-directed Lean initiatives at the Robert Wood Johnson University Hospital. The article concludes with some lessons we have learned and implications for nursing education in the future that must include the concepts, tools, and skills required for adapting Lean to the patient care environment.

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“…Queuing theory was used to study waiting time, 20 and structural design principles guided the redesign of work unit structures, or "pods," and the proximity of staff and supply carts to the point of use. 21 Demand management was addressed through use of a full-capacity protocol, a strategy used in the United States 22,23 and abroad [24][25][26][27] to move low-risk boarded patients out of the emergency department and to inpatient floors. The focus was achieving maximum output with the minimum input and delay, that is, moving patients through critical ED activities in ways that decrease the disposition-to-discharge interval.…”

Section: Process Redesignmentioning

confidence: 99%

Redesign of an Urban Academic Emergency Department: Action Research Can Make a Difference

Ciambrone

Zavotsky

Souto

et al. 2012

Journal of Emergency Nursing

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Full capacity protocol: an end to double standards in acute hospital care provision

Cited by 5 publications

References 35 publications

The probability of patients being admitted from the emergency department is negatively correlated to in-hospital bed occupancy – a registry study

The probability of patients being admitted from the emergency department is negatively correlated to in-hospital bed occupancy – a registry study

From Toyota to the Bedside

Redesign of an Urban Academic Emergency Department: Action Research Can Make a Difference

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