Impact of inpatient Care in Emergency Department on outcomes: a quasi-experimental cohort study

被引：8

作者：

Lateef, Aisha ^{[1
,2
]}

Lee, Soo Hoon ^{[2
,3
,4
]}

Fisher, Dale Andrew ^{[1
,2
]}

Goh, Wei-Ping ^{[1
]}

Han, Hui Fen ^{[1
]}

Segara, Uma Chandra ^{[5
]}

Sim, Tiong Beng ^{[5
]}

Mahadehvan, Malcolm ^{[5
]}

Goh, Khean Teik ^{[6
]}

Cheah, Noel ^{[6
]}

Lim, Aymeric Y. T. ^{[2
,7
]}

Phan, Phillip H. ^{[2
,8
,9
]}

Merchant, Reshma A. ^{[1
,2
]}

机构：

[1] Natl Univ Singapore Hosp, Univ Med Cluster, 1E Kent Ridge Rd, Singapore 119074, Singapore

[2] Natl Univ Singapore, Yong Loo Lin Sch Med, 12 Sci Dr 2, Singapore 117549, Singapore

[3] Johns Hopkins Carey Business Sch, 100 Int Dr, Baltimore, MD 21202 USA

[4] Old Dominion Univ, Strome Coll Business, 2027 Constant Hall, Norfolk, VA 23529 USA

[5] Natl Univ Singapore Hosp, Dept Emergency Med, 1E Kent Ridge Rd, Singapore 119074, Singapore

[6] Natl Univ Singapore Hosp, 1E Kent Ridge Rd, Singapore 119074, Singapore

[7] Natl Univ Singapore Hosp, Dept Hand & Reconstruct Microsurg, 1E Kent Ridge Rd, Singapore 119074, Singapore

[8] Johns Hopkins Univ, Carey Business Sch, 100 Int Dr, Baltimore, MD 21202 USA

[9] Johns Hopkins Univ, Dept Med, 100 Int Dr, Baltimore, MD 21202 USA

来源：

BMC HEALTH SERVICES RESEARCH | 2017年 / 17卷

关键词：

Emergency department; Boarders; Bed occupancy rates; Inpatient care; Length of stay; Bed allocation; Readmissions; UNITED-STATES; VALIDATION; LENGTH; STAY;

D O I：

10.1186/s12913-017-2491-x

中图分类号：

R19 [保健组织与事业（卫生事业管理）];

学科分类号：

摘要：

Background: Hospitals around the world are faced with the issue of boarders in emergency department (ED), patients marked for admission but with no available inpatient bed. Boarder status is known to be associated with delayed inpatient care and suboptimal outcomes. A new care delivery system was developed in our institution where boarders received full inpatient care from a designated medical team, acute medical team (AMT), while still residing at ED. The current study examines the impact of this AMT intervention on patient outcomes. Methods: We conducted a retrospective quasi-experimental cohort study to analyze outcomes between the AMT intervention and conventional care in a 1250-bed acute care tertiary academic hospital in Singapore. Study participants included patients who received care from the AMT, a matched cohort of patients admitted directly to inpatient wards (non-AMT) and a sample of patients prior to the intervention (pre-AMT group). Primary outcomes were length of hospital stay (LOS), early discharges (within 24 h) and bed placement. Secondary outcomes included unplanned readmissions within 3 months, and patient's bill size. X-2- and Mann-Whitney U tests were used to test for differences between the cohorts on dichotomous and continuous variables respectively. Results: The sample comprised of 2279 patients (1092 in AMT, 1027 in non-AMT, and 160 in pre-AMT groups). Higher rates of early discharge (without significant differences in the readmission rates) and shorter LOS were noted for the AMT patients. They were also more likely to be admitted into a ward allocated to their discipline and had lower bill size compared to non AMT patients. Conclusions: The AMT intervention improved patient outcomes and resource utilization. This model was noted to be sustainable and provides a potential solution for hospitals' ED boarders who face a gap in inpatient care during their crucial first few hours of admissions while waiting for an inpatient bed.

引用

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