The Effect of a Rapid Assessment Zone on Emergency Department Operations and Throughput

Anderson, Jared; Burke, Ryan; Augusto, Kevin D.; Beagan, Brianne; Rodrigues-Belong, Michele L.; Frazer, Lori S.; Stack, Colin; Shukla, Anil Kumar; Pope, Jen V.

doi:10.1016/j.annemergmed.2019.07.047

Cited by 16 publications

(26 citation statements)

References 18 publications

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“…Integration of isolated waiting room areas for potentially infectious patients who were otherwise stable allowed for a two-tiered approach to patient throughput. In addition, some studies that were published after the initiation of this study suggested other configurations (Franklin et al, 2020; Payne et al, 2020) or found other advantages of the retrieved strategies in the present study (Ahmadpour et al, 2021; Anderson et al, 2020; Martin et al, 2021; Valipoor et al, 2021) that provide insight for the future studies.…”

Section: Discussionmentioning

confidence: 58%

Toward Building Surge Capacity: Potentially Effective Spatial Configurations in Emergency Departments

Valipoor

Hakimjavadi

Nobles

2022

HERD

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Background: Emergency departments (EDs) have been struggling with overcrowding issues for years. Some spatial configurations have been proposed to improve ED performance in facing overcrowding. Despite similarities with mass casualty incidents (MCIs), when demand for care exceeds the capacity, little is documented about the application of the proposed configurations during MCIs to improve surge capacity. Objectives: We aimed to explore the potential of spatial configurations that have been proposed to handle ED overcrowding in daily operations so as to improve surge capacity during MCIs. Methods: Using an online Likert-scale survey, 11 spatial design strategies were rated by ED care teams in terms of their potential to improve surge capacity during MCIs. Results: Responses from 72 participants revealed that establishing an in-house lab was perceived as the most potential strategy, followed by rapid care area, internal waiting rooms, and in-house imaging. In contrast, separate entrance and exit doors, as well as decentralized nurse stations, were perceived as the least potential strategies but also exhibited the most variance in response. Respondents’ comments implied that their choice of in-house ancillary services was primarily to improve communication and to reduce turnaround time and risk of errors. Their choice of rapid care and internal waiting areas related to improved flexibility. Conclusions: Understanding clinicians’ perspectives on potentially effective spatial configurations aids in implementing balanced strategies to better equip EDs to handle overcrowding in daily operations and manage surges during MCIs.

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Section: Discussionmentioning

confidence: 58%

Toward Building Surge Capacity: Potentially Effective Spatial Configurations in Emergency Departments

Valipoor

Hakimjavadi

Nobles

2022

HERD

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“…A common ED strategy for enhancing throughput of these patients has been to deploy a "fast-track" or "quick-care" model during periods of high census. 25,26 Compared with our local patient population, in-state nonlocal patients presented to the ED at a consistent rate throughout the year, had a higher average triage acuity, and had greater resource utilization in terms of laboratory tests and imaging ordered. In addition, in-state nonlocal patients were more than 4 times as likely to be admitted and had a longer average HLOS compared with local and out-of-state patients.…”

Section: Discussionmentioning

confidence: 89%

“…The increased burden of high-volume, low-acuity visits that local patients tend to present with can be mitigated through improved parental education and access to primary care physicians. A common ED strategy for enhancing throughput of these patients has been to deploy a “fast-track” or “quick-care” model during periods of high census 25,26 …”

Section: Discussionmentioning

confidence: 99%

Pediatric ED Utilization in a Destination City

2022

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Objectives: Seasonal variation in emergency department (ED) visits has been shown for a variety of pediatric conditions, but previous studies have not considered how geographic location may also influence when and why these patients present to the ED. Our study examined the demographic and clinical characteristics as well as the seasonal variation among 3 patient populations (locals, in-state nonlocals, and out-of-state visitors) presenting to our pediatric ED (PED), which is located in a coastal, destination city.Methods: This was a retrospective chart review of PED visits from June 2014 to June 2019 at the Medical University of South Carolina Children's Hospital, a tertiary care facility located in Charleston, SC. Pediatric ED encounters were divided into 3 groups, depending on the patient's home address: local patients residing in the 3 surrounding metro counties, in-state but nonlocal patients, and out-of-state patients. Demographic and clinical information was abstracted for each visit and compared among the 3 patient groups. Seasonal variation among PED visits was determined by recording the week of the year during which each visit occurred. Results:Local patients accounted for more than 90% of PED visits with increases in visits from October to April. In-state nonlocal patients presented at consistent rates throughout the year, whereas out-of-state ED utilization peaked significantly during the summer months, Spring Break, Thanksgiving, and Christmas. Our local patient population was majority African American; our in-state nonlocal patients roughly matched our state's racial demographics, and our out-of-state population was predominantly White. Compared with in-state nonlocal patients, our local patients were more likely to present with an infection-related complaint and be diagnosed with lower-acuity conditions such as viral infection, otitis media, upper respiratory infection, cough, fever, and gastroenteritis. In-state nonlocal patients had the highest average triage acuity, more frequently had laboratory tests and imaging ordered, and were more than 4.5 times as likely to be admitted to the hospital compared with our local patients. In-state nonlocal patients were also more likely to present with a psychiatric chief complaint compared with our local patients. Out-of-state patients had a similar overall acuity to local patients but were more likely to have imaging ordered and be diagnosed with injuries such as fractures. Conclusion:At our institution, local patients, in-state nonlocal patients, and out-of-state patients exhibited 3 distinct patterns of PED utilization. Knowledge of these trends can be used to optimize resource allocation and follow-up planning, particularly for our out-of-state patient population.

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“… 6 However, a given OR may not have equal effects on the level of crowding and the quality of care at different EDs because of the different operational models or patient population differences. 9 , 10 , 11 , 15 Furthermore, there is evidence that the effect of crowding on patient outcome is non‐linear, 1 , 2 , 3 with more of the negative effects at the highest crowding levels. The observed differences in TTB between EDs in our study and the non‐linear relation between crowding and quality of care may explain some of the mixed results from studies using OR as a measure of crowding.…”

Section: Discussionmentioning

confidence: 99%

“… 8 To our knowledge, differences in census to treatment bed ratios have not been investigated, and neither is there a regulated minimum ratio for the number of treatment beds in the ED. In addition, there are several different operational models for EDs, such as fast‐track, 9 rapid assessment zones, 10 and vertical split flow, 11 which use ED space and treatment beds differently.…”

Section: Introductionmentioning

confidence: 99%

Differentiating properties of occupancy rate and workload to estimate crowding: A Swedish national cross‐sectional study

2022

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Background Emergency department (ED) crowding causes increased patient morbidity and mortality. ED occupancy rate (OR; patients by treatment beds) is a common measure of crowding, but the comparability of ORs between EDs is unknown. The objective of this investigation was to investigate differences in ORs between EDs using staff‐perceived workload as reference. Methods This was a national cross‐sectional study in Sweden. EDs provided data on census, treatment beds, staffing, and workload (1–6) at 5 time points. A baseline patient turnover was calculated as the average daily census by treatment beds, denoted turnover per treatment bed (TTB), for each ED. A census ratio (CR), current by daily census, was calculated to adjust for differences in the number of treatment beds. Results Data were returned from 37 (51%) EDs. TTB varied considerably (mean = 4, standard deviation = 1.6; range, 2.1–9.2), and the OR was higher in EDs with TTB >4 compared with ≤4, 0.86 versus 0.43 (0.43; 95% confidence interval [CI], 0.27–0.59), but not workload, 2.75 versus 2.52 (0.23; 95% CI, −0.19 to 0.64). After adjusting for confounders, both TTB ( k = − 0.3; 95% CI, −0.49 to −0.14) and OR ( k = 3.4; 95% CI, 1.76–5.03) affected workload. Correlation with workload was better for CR than for OR ( r = 0.75 vs 0.60, respectively). Conclusion OR is affected by patient‐to‐treatment bed ratios that differ significantly between EDs and should be accounted for when measuring crowding. CR is not affected by baseline treatment beds and is a better comparable measure of crowding compared with OR in this national comparator study.

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The Effect of a Rapid Assessment Zone on Emergency Department Operations and Throughput

Cited by 16 publications

References 18 publications

Toward Building Surge Capacity: Potentially Effective Spatial Configurations in Emergency Departments

Toward Building Surge Capacity: Potentially Effective Spatial Configurations in Emergency Departments

Pediatric ED Utilization in a Destination City

Differentiating properties of occupancy rate and workload to estimate crowding: A Swedish national cross‐sectional study

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