Using emergency physicians’ abilities to predict patient admission to decrease admission delay time
| Autor: | Erica E M Lee, Edmund S H Kwok, Christian Vaillancourt |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty Time Factors Evening Critical Care and Intensive Care Medicine 03 medical and health sciences 0302 clinical medicine Predictive Value of Tests medicine Humans Prospective Studies 030212 general & internal medicine Prospective cohort study Referral and Consultation Aged Ontario business.industry Process Assessment Health Care 030208 emergency & critical care medicine Mean age General Medicine Emergency department Middle Aged Crowding Predictive value Triage Hospitalization Emergency medicine Emergency Medicine Female Clinical Competence Emergency Service Hospital business Delay time |
| Zdroj: | Emergency Medicine Journal. 37:417-422 |
| ISSN: | 1472-0213 1472-0205 |
| DOI: | 10.1136/emermed-2019-208859 |
| Popis: | BackgroundIn many EDs, emergency physicians (EPs) do not have admitting privileges and must wait for consultants to further assess and admit patients. This delays bed requests and increases ED crowding. We measured EPs’ abilities to predict patient admission prior to consultation and estimated the potential ED stretcher time saved if EPs requested a bed with consultation.MethodsWe conducted a prospective cohort study in an academic centre in Canada between October 2017 and February 2018 using a convenience sample of ED patient encounters requiring consultation. We excluded patients under 18 years or those clearly likely to be admitted (traumas, strokes, S-T elevation myocardial infarctions and Canadian Triage and Acuity Scale of 1). EPs predicted patient admission just before consultation. Potential ED stretcher time saved was estimated for correctly predicted admissions assuming bed requests were initiated with consultation and a constant time to inpatient bed.ResultsCharacteristics of 454 patients were: mean age 60.1 years, 48.5% male, 46.9% evening presentation, 69.4% admitted and median time to bed request of 3.5 hours (IQR 2.0–5.3 hours). Overall, EPs prediction sensitivity, specificity, positive predictive value and negative predictive value were 90.5% (95% CI 86.7% to 93.5%), 84.2% (95% CI 77.0% to 89.8%), 92.8% (95% CI 89.8% to 95.0%) and 79.6% (95% CI 73.4% to 84.7%). Approximately 922.1 hours of ED stretcher time could have been saved during the 5-month study period if EPs initiated a bed request with consultation.ConclusionCrowding is a reality for EDs worldwide, and many systems could benefit from EP-initiated hospital admissions to decrease the amount of time admitted patients wait in the ED. |
| Databáze: | OpenAIRE |
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