Decreasing Emergency Department Walkout Rate and Boarding Hours by Improving Inpatient Length of Stay

Autor: Andrew Artenstein, Niels Rathlev, Douglas Neal, Vernette Townsend, Michael Vemula, Sheila Goldlust, Joseph Schmidt, Paul Visintainer, Michael Albert, Glenn Alli, Jacqualyn Anderson, Penny Bertolasio, Robert Bourgeault, Christine Bryson, Stephanie Calcasola, Gregory Delozier, Shawna Edwards, Tala Elia, Lynn Garreffi, Bonnie Geld, Molly Gray, Eileen Grunwald, David Hansen, Joeli Hettler, Thomas Higgins, Kevin Hinchey, Satoko Igarashi, Farzan Irani, Christine Klucznik, Ari Kugelmass, Christopher LaChance, Betty LaRue, Haiping Li, Amir Lotfi, Kathleen Mahoney, Yolanda Marrow, Jan Mayforth, Maura McQueeny, Alicia Meacham, Venkatrao Medarametla, Debra Meyer, Michael Moran, Sivakumar Natanasabapathy, Tara Pappas, Patricia Perkins, Lynn Perry, Janine Prokop, Deb Provost, Christine Raco, Carlo Reale, Carol Richardson, Doug Salvador, Patty Samra, Christine Scibelli, Sundeep Shukla, Bev Siano, Jennifer Silvestri, Debbie Smith, Melissa Tuomi
Jazyk: angličtina
Rok vydání: 2017
Předmět:
medicine.medical_specialty
Patient Dropouts
Time Factors
Process improvement
lcsh:Medicine
Efficiency
Organizational
Tertiary care
03 medical and health sciences
0302 clinical medicine
Patient Admission
Health care
Severity of illness
medicine
Humans
In patient
030212 general & internal medicine
Original Research
Patient Care Team
Academic Medical Centers
business.industry
lcsh:R
lcsh:Medical emergencies. Critical care. Intensive care. First aid
ED Crowding
030208 emergency & critical care medicine
General Medicine
Emergency department
lcsh:RC86-88.9
Walkouts. ED Boarding
Length of Stay
medicine.disease
Quality Improvement
Patient Discharge
Hospital medicine
Hospitalization
Emergency medicine
Emergency Medicine
Medical emergency
Operational effectiveness
Emergency Department Operations
business
Emergency Service
Hospital
Delivery of Health Care
Zdroj: Western Journal of Emergency Medicine
Artenstein, Andrew W.; Rathlev, Niels K.; Neal, Douglas; Townsend, Vernette; Vemula, Michael; Goldlust, Sheila; et al.(2017). Decreasing Emergency Department Walkout Rate and Boarding Hours by Improving Inpatient Length of Stay. Western Journal of Emergency Medicine, 18(6). doi: 10.5811/westjem.2017.7.34663. Retrieved from: http://www.escholarship.org/uc/item/9hh3r9vb
Western Journal of Emergency Medicine, Vol 18, Iss 6 (2017)
ISSN: 1936-9018
1936-900X
Popis: Author(s): Artenstein, Andrew W.; Rathlev, Niels K.; Neal, Douglas; Townsend, Vernette; Vemula, Michael; Goldlust, Sheila; Schmidt, Joseph; Visintainer, Paul | Abstract: Introduction: Patient progress, the movement of patients through a hospital system from admission todischarge, is a foundational component of operational effectiveness in healthcare institutions. Optimalpatient progress is a key to delivering safe, high-quality and high-value clinical care. The Baystate PatientProgress Initiative (BPPI), a cross-disciplinary, multifaceted quality and process improvement project, waslaunched on March 1, 2014, with the primary goal of optimizing patient progress for adult patients.Methods: The BPPI was implemented at our system’s tertiary care, academic medical center, a highvolume,high-acuity hospital that serves as a regional referral center for western Massachusetts. TheBPPI was structured as a 24-month initiative with an oversight group that ensured collaborative goalalignment and communication of operational teams. It was organized to address critical aspects ofa patient’s progress through his hospital stay and to create additional inpatient capacity. The specificgoal of the BPPI was to decrease length of stay (LOS) on the inpatient adult Hospital Medicine serviceby optimizing an interdisciplinary plan of care and promoting earlier departure of discharged patients.Concurrently, we measured the effects on emergency department (ED) boarding hours per patient andwalkout rates.Results: The BPPI engaged over 300 employed clinicians and non-clinicians in the work. We createdincreased inpatient capacity by implementing daily interdisciplinary bedside rounds to proactively addresspatient progress; during the 24 months, this resulted in a sustained rate of discharge orders writtenbefore noon of more than 50% and a decrease in inpatient LOS of 0.30 days (coefficient: -0.014, 95%CI [-0.023, -0.005] Pl 0.005). Despite the increase in ED patient volumes and severity of illness overthe same time period, ED boarding hours per patient decreased by approximately 2.1 hours (coefficient:-0.09; 95% CI [-0.15, -0.02] P = 0.007). Concurrently, ED walkout rates decreased by nearly 32% to amonthly mean of 0.4 patients (coefficient: 0.4; 95% CI [-0.7, -0.1] P= 0.01).Conclusion: The BPPI realized significant gains in patient progress for adult patients by promotingearlier discharges before noon and decreasing overall inpatient LOS. Concurrently, ED boarding hoursper patient and walkout rates decreased.
Databáze: OpenAIRE
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