THE RELATIONSHIP BETWEEN INPATIENT DISCHARGE TIMING AND EMERGENCY DEPARTMENT BOARDING

被引:102
作者
Powell, Emilie S. [1 ,2 ,3 ]
Khare, Rahul K. [1 ,2 ,3 ]
Venkatesh, Arjun K. [4 ]
Van Roo, Ben D. [5 ]
Adams, James G. [1 ]
Reinhardt, Gilles [6 ]
机构
[1] Northwestern Univ, Dept Emergency Med, Feinberg Sch Med, Chicago, IL 60611 USA
[2] Northwestern Univ, Inst Healthcare Studies, Chicago, IL 60611 USA
[3] Northwestern Univ, Div Gen Internal Med, Chicago, IL 60611 USA
[4] Massachusetts Gen Hosp, Brigham & Womens Hosp, Boston, MA 02114 USA
[5] RAND Corp, Santa Monica, CA USA
[6] Depaul Univ, Dept Management, Chicago, IL 60604 USA
基金
美国医疗保健研究与质量局;
关键词
boarding; crowding; operations; admitting patients; discharging patients; ADMITTED PATIENTS; OPPORTUNITY LOSS; ASSOCIATION; MANAGEMENT; HOSPITALS; CAPACITY;
D O I
10.1016/j.jemermed.2010.06.028
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Background: Patient crowding and boarding in Emergency Departments (EDs) impair the quality of care as well as patient safety and satisfaction. Improved timing of inpatient discharges could positively affect ED boarding, and this hypothesis can be tested with computer modeling. Study Objective: Modeling enables analysis of the impact of inpatient discharge timing on ED boarding. Three policies were tested: a sensitivity analysis on shifting the timing of current discharge practices earlier; discharging 75% of inpatients by 12:00 noon; and discharging all inpatients between 8:00 a.m. and 4:00 p.m. Methods: A cross-sectional computer modeling analysis was conducted of inpatient admissions and discharges on weekdays in September 2007. A model of patient flow streams into and out of inpatient beds with an output of ED admitted patient boarding hours was created to analyze the three policies. Results: A mean of 38.8 ED patients, 22.7 surgical patients, and 19.5 intensive care unit transfers were admitted to inpatient beds, and 81.1 inpatients were discharged daily on September 2007 weekdays: 70.5%, 85.6%, 82.8%, and 88.0%, respectively, occurred between noon and midnight. In the model base case, total daily admitted patient boarding hours were 77.0 per day; the sensitivity analysis showed that shifting the peak inpatient discharge time 4 h earlier eliminated ED boarding, and discharging 75% of inpatients by noon and discharging all inpatients between 8:00 a.m. and 4:00 p.m. both decreased boarding hours to 3.0. Conclusion: Timing of inpatient discharges had an impact on the need to board admitted patients. This model demonstrates the potential to reduce or eliminate ED boarding by improving inpatient discharge timing in anticipation of the daily surge in ED demand for inpatient beds. (C) 2012 Elsevier Inc.
引用
收藏
页码:186 / 196
页数:11
相关论文
共 30 条
[1]  
Agency for Healthcare Research and Quality, INN PROF COMPR EM DE
[2]  
*AM COLL EM PHYS T, 2008, EM DEP CROWD HIGH IM
[3]   Dynamics of bed use in accommodating emergency admissions: stochastic simulation model [J].
Bagust, A ;
Place, M ;
Posnett, JW .
BRITISH MEDICAL JOURNAL, 1999, 319 (7203) :155-158
[4]   The financial burden of emergency department congestion and hospital crowding for chest pain patients awaiting admission [J].
Bayley, MD ;
Schwartz, JS ;
Shofer, FS ;
Weiner, M ;
Sites, FD ;
Traber, KB ;
Hollander, JE .
ANNALS OF EMERGENCY MEDICINE, 2005, 45 (02) :110-117
[5]   The Effect of Emergency Department Crowding on Clinically Oriented Outcomes [J].
Bernstein, Steven L. ;
Aronsky, Dominik ;
Duseja, Reena ;
Epstein, Stephen ;
Handel, Dan ;
Hwang, Ula ;
McCarthy, Melissa ;
McConnell, K. John ;
Pines, Jesse M. ;
Rathlev, Niels ;
Schafermeyer, Robert ;
Zwemer, Frank ;
Schull, Michael ;
Asplin, Brent R. .
ACADEMIC EMERGENCY MEDICINE, 2009, 16 (01) :1-10
[6]  
*COMM FUT EM CAR U, 2006, HOSP BAS EM CAR BREA
[7]   Prolonged emergency department stays of non-ST-segment-elevation myocardial infarction patients are associated with worse adherence to the American College of Cardiology/American Heart Association guidelines for management and increased adverse events [J].
Diercks, Deborah B. ;
Roe, Matthew T. ;
Chen, Anita Y. ;
Peacock, W. Franklin ;
Kirk, J. Douglas ;
Pollack, Charles V., Jr. ;
Gibler, W. Brian ;
Smith, Sidney C., Jr. ;
Ohman, Magnus ;
Peterson, Eric D. .
ANNALS OF EMERGENCY MEDICINE, 2007, 50 (05) :489-496
[8]   The opportunity loss of boarding admitted patients in the emergency department [J].
Falvo, Thomas ;
Grove, Lance ;
Stachura, Ruth ;
Vega, David ;
Stike, Rose ;
Schlenker, Melissa ;
Zirkin, William .
ACADEMIC EMERGENCY MEDICINE, 2007, 14 (04) :332-337
[9]  
Forster AJ, 2003, ACAD EMERG MED, V10, P127, DOI 10.1197/aemj.10.2.127
[10]   Emergency department patient preferences for boarding locations when hospitals are at full capacity [J].
Garson, Chad ;
Hollander, Judd E. ;
Rhodes, Karin V. ;
Shofer, Frances S. ;
Baxt, William G. ;
Pines, Jesse M. .
ANNALS OF EMERGENCY MEDICINE, 2008, 51 (01) :9-12