Hospitalist‐led medicine emergency department team: Associations with throughput, timeliness of patient care, and satisfaction

Chadaga, Smitha R.; Shockley, Lee W.; Keniston, Angela; Klock, Nancy E.; Dyke, Susan Van; Davis, Quin; Chu, Eugene S.

doi:10.1002/jhm.1957

Cited by 23 publications

(43 citation statements)

References 19 publications

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“…Other models focused on expediting the admission process and ED throughput have included a hospital medicine ED team (11) and rounding as well as hospitalists running an ED/inpatient unit (12). Regardless of the model details, collaboration between the physicians on the referring and accepting teams (including ED, hospitalists and intensivists) requires effective coordination and communication.…”

Section: Discussionmentioning

confidence: 99%

Before the Flood

Webber¹,

Bauer²,

Marcum³

et al. 2018

Pediatr Emer Care

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Background Transfers of pediatric patients occur to access specialty and subspecialty care, but incur risk, and consume resources. Direct admissions to medical and surgical wards may improve patient experience and mitigate resource utilization. Objective We sought to identify common elements for direct admissions, as well as the pattern of disposition for patients referred to our emergency department (ED). Design A retrospective qualitative analysis of patients transferred to our pediatric hospital for 12 months was performed. Different physician groups were evaluated for use of direct admissions or evaluation in the ED. Patients referred to the ED were additionally tracked to evaluate their eventual disposition. Results A total of 3982 transfers occurred during the 12-month analysis period. Of those, 3463 resulted in admission, accounting for 32.55% of all admissions. Transfers accepted by nonsurgical services accounted for 82% of the transfers, whereas 18% were facilitated by one of the surgical services. Direct admissions accounted for 1707 (44.8%) of all referrals and were used more often by nonsurgical services. Of patients referred to the ED (2101 or 55.2% of all referrals), most patients were admitted and 343 (16% of those referred to the ED) were discharged home. Conclusions The direct admission process helped avoid ED assessments for some patients; however, some patients referred to the ED were able to be evaluated, treated, and discharged. Consistent triage of the patients being transferred as direct admissions may improve ED throughput and potentially improve the patient's experience, reduce redundant services, and expedite care.

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Section: Discussionmentioning

confidence: 99%

Before the Flood

Webber¹,

Bauer²,

Marcum³

et al. 2018

Pediatr Emer Care

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“…In some models of care, hospitalist physicians successfully facilitate appropriate placement of ED patients with positive outcomes 6,7,8. In large, complex organizations, however, proper bed assignment and placement of inpatients is often delegated to case management in collaboration with ED and admitting physicians.…”

Section: Discussionmentioning

confidence: 99%

Reducing Patient Placement Errors in Emergency Department Admissions: Right Patient, Right Bed

Rathlev¹,

Bryson²,

Samra³

et al. 2014

WestJEM

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IntroductionBecause lack of inpatient capacity is associated with emergency department (ED) crowding, more efficient bed management could potentially alleviate this problem. Our goal was to assess the impact of involving a patient placement manager (PPM) early in the decision to hospitalize ED patients. The PPMs are clinically experienced registered nurses trained in the institution-specific criteria for correct unit and bed placement.MethodsWe conducted two pilot studies that included all patients who were admitted to the adult hospital medicine service: 1) 10/24 to 11/22/2010 (30 days); and 2) 5/24 to 7/4/2011 (42 days). Each pilot study consisted of a baseline control period and a subsequent study period of equal duration. In each pilot we measured: 1) the number of “lateral transfers” or assignment errors in patient placement, 2) median length of stay (LOS) for “all” and “admitted” patients and 3) inpatient occupancy. In pilot 2, we added as a measure code 44s, i.e. status change from inpatient to observation after patients are admitted, and also equipped all emergency physicians with portable phones in order to improve the efficiency of the process.ResultsIn pilot 1, the number of “lateral transfers” (incorrect patient placement assignments) during the control period was 79 of the 854 admissions (9.3%) versus 27 of 807 admissions (3.3%) during the study period (P<0.001). We found no statistically significant differences in inpatient occupancy or ED LOS for “all” or for “admitted” patients. In pilot 2, the number of “lateral transfers” was 120 of 1,253 (9.6%) admissions in the control period and 42 of 1,229 (3.4%) admissions in the study period (P<0.001). We found a 49-minute (352 vs. 401 minutes) decrease in median LOS for “admitted” ED patients during the study period compared with the control period (P=0.04). The code 44 rates, median LOS for “all” patients and inpatient occupancy did not change.ConclusionInclusion of the PPM in a three-way handoff conversation between emergency physicians and hospitalist providers significantly decreased the number of “lateral transfers.” Moreover, adding status determination and portable phones for emergency physicians improved the efficiency of the process and was associated with a 49 (12%) minute decrease in LOS for admitted patients.

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“…[36] Some settings have used hospitalists in the ED or hospital rather than geriatricians to staff the ACE unit. [90, 91]…”

Section: The Geriatric Emergency Departmentmentioning

confidence: 99%

Evolving Prehospital, Emergency Department, and “Inpatient” Management Models for Geriatric Emergencies

Carpenter

Platts‐Mills

2013

Clinics in Geriatric Medicine

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Alternative management methods are essential to ensure high quality and efficient emergency care for the growing number of geriatric adults worldwide. Protocols for case-finding and rapid diagnosis to support early condition-specific treatment for older adults with acute severe illness and injury are needed. Improved emergency department care for older adults will require providers to look beyond the diagnosis to address the influence of other factors on the patient's health: isolation and depression; finances and transportation; and chronic medical conditions and polypharmacy. This review article describes recent and ongoing efforts to enhance the quality of emergency care for older adults using alternative management approaches spanning the spectrum from prehospital care, through the emergency department, and into evolving inpatient or outpatient processes of care.

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Hospitalist‐led medicine emergency department team: Associations with throughput, timeliness of patient care, and satisfaction

Cited by 23 publications

References 19 publications

Before the Flood

Before the Flood

Reducing Patient Placement Errors in Emergency Department Admissions: Right Patient, Right Bed

Evolving Prehospital, Emergency Department, and “Inpatient” Management Models for Geriatric Emergencies

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