SISTER (system implementation of select transfers in emergency room) model to reduce ED boarding.

Autor: Westlake E; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States of America., Slovis BH; Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States of America; Office of the Clinical Informatics, Thomas Jefferson University, Philadelphia, PA, United States of America., Koutsoubis A; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States of America., Ney D; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States of America., Randolph F; Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States of America., Procopio J; Department of Hospitalist Medicine, Jefferson Methodist Hospital, Thomas Jefferson University, Philadelphia, PA, United States of America., London K; Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States of America., Flickinger S; Office of the Clinical Informatics, Thomas Jefferson University, Philadelphia, PA, United States of America., Levitt J; The Wharton School, University of Pennsylvania, Philadelphia, PA, United States of America., Klasko SK; Thomas Jefferson University, Philadelphia, PA, United States of America., White JL; Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States of America. Electronic address: Jennifer.white@jefferson.edu.
Jazyk: angličtina
Zdroj: The American journal of emergency medicine [Am J Emerg Med] 2023 Mar; Vol. 65, pp. 185-189. Date of Electronic Publication: 2022 Dec 22.
DOI: 10.1016/j.ajem.2022.12.028
Abstrakt: Objective: This study describes a novel transfer model implemented between an academic, level 1 trauma center (Hospital A) and a nearby affiliate community hospital (Hospital B). Primary outcome is change in boarding hours and percentage of boarders in the Hospital A emergency department. Secondary objectives of this study include how improved flow in the emergency department to reduce boarding improves length of stay, prevents patients from escalating to more acute acuity levels of care, reduces patient morbidity and mortality and therefore improves health care costs as well.
Methods: A retrospective chart review was conducted over a consecutive 14-months period of all patients that presented to main hospital emergency department who were transferred to the Hospital B for inpatient admission. This included analysis of patient cohort characteristics, hospital LOS, return rate to the Hospital A (boomerang), rates of against medical advice (AMA) dispositions, post-discharge recidivism, in addition to enterprise data on total number of boarders, percent of boarders, and total boarding hours.
Results: There was a total of 718 transfer encounters during the study period. Percent boarding decreased from 70.6% in the pre-period to 63.8% in the post-period (p < 0.001). Total boarding hours decreased at both the main hospital and the sister hospital with this transfer process. The median length of stay at the sister hospital was 74 h, with 9 upgrades to ICU admissions. Five patients were dispositioned back to the hospital A after admission to hospital B.
Conclusion: A distributive model was useful in transferring admissions within a healthcare system, reducing number of boarders, percent of boarders, and boarding hours in Hospital A emergency department. Furthermore, the Hospital B was an appropriate location for transfers, based on the low number of ICU transfers and dispositions back to the main hospital.
Competing Interests: Declaration of Competing Interest None of the authors have conflicts of interest or competing interests to declare.
(Copyright © 2022 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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