Can a Change in the Process of Transferring Patients from the Emergency Department to the Inpatient Acute Care Units Improve the Problem of Overcrowding?
Başlık:
Can a Change in the Process of Transferring Patients from the Emergency Department to the Inpatient Acute Care Units Improve the Problem of Overcrowding?
Yazar:
Cippel, Marie, author.
ISBN:
9780438003231
Yazar Ek Girişi:
Fiziksel Tanımlama:
1 electronic resource (53 pages)
Genel Not:
Source: Dissertation Abstracts International, Volume: 79-10(E), Section: B.
Advisors: Renee Ingel; Kathleen Schenkel.
Özet:
Background: Overcrowding is an ongoing problem in the ED of the US which results in increasing issues, such as delayed patient transferring, increase length of stay, sepsis, and death. According to the IOM (2006), ED visits have been rapidly increasing over the years. Simultaneously, the number of facilities available to treat these visits have been decreasing (IOM, 2006).
Problem: Overcrowding in the ED can be caused by the inability to quickly transfer ED patients to inpatient beds once the patient is ready to be admitted. In a pediatric hospital, a quality improvement process was implemented to reduce the time of transfer from ED to inpatient floors.
Methods: A 4-year retrospective study evaluated whether a quality improvement process change reduced the time of transferring patients from the ED to the inpatient units. The following aggregate data was compared to the time of transferring patients from the ED to the acute care units for the 24-months post-intervention to evaluate the effectiveness of the process change on overcrowding: Average length of stay in the ED ≤ 60 minutes and ≥ 275 minutes, the number of patients admitted to an acute care floor ≤ 20 and ≥ 45, the productivity level ≤ 95% and ≥ 105%, the acute care floor's census < and ≥ 285 patients, the ED's census < and ≥ 250 patients, the number of patients admitted and held in the ED ≥ 10 patients, and the number of patients boarded overnight in the ED ≥ 10 patients.
Interventions: There were eight acute care floors in the hospital selected for this study that all followed the same transfer process. The aggregate data collected focused on daily averages.
Results: The average time of transferring patients from the ED to the inpatient units for the 24-months prior to the quality improvement process change was 90.92 minutes compared to 100 minutes (p=0.009) for the 24 months post. The following aggregate data was compared to the time of transferring patients from the ED to the acute care units for the 24 months post-intervention to evaluate the effectiveness of the process change on overcrowding: Average length of stay in the ED ≥ 275 minutes= 104 minutes, the number of patients admitted to an acute care floor ≤ 20 =72 minutes and ≥ 45 =93 minutes (p=0.005), the productivity level ≥ 105%= 106 minutes, the acute care floor's census <285 patients = 94 minutes and ≥ 285 patients = 135 minutes (p=<0.0001), the ED's census <250 patients= 98 minutes and ≥ 250 patients=106 minutes (p=0.19). No results reported for the number of patients admitted and held in the ED and boarded overnight in the ED.
Conclusion: The change in the transfer process increased the amount of time of transferring patients from the ED to the acute care units. The number of patients admitted from the ED to the acute care unit and the acute care unit's census did increase the time of transferring patients from the ED to the acute care unit. The length of stay in the ED, productivity level, and the ED census did not have an effect on the time of transferring patients from the ED to the acute care units.
Notlar:
School code: 1671
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Yer Numarası | Demirbaş Numarası | Shelf Location | Lokasyon / Statüsü / İade Tarihi |
---|---|---|---|
XX(682198.1) | 682198-1001 | Proquest E-Tez Koleksiyonu | Arıyor... |
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