SESSION TITLE: Process Improvement in Obstructive Lung Disease Education, Pneumonia Readmissions and Rapid Response Systems I
SESSION TYPE: Original Investigation Poster
PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM
PURPOSE: It is well known that increased ED wait times are associated with increased mortality, low patient satisfaction and poor access to services. Less is known about the effect of waiting for consultation in the ED before disposition. Veteran’s Affairs (VA) hospitals represent a unique healthcare system. Their ED facilities serve few female and pediatric patients and typically do not encounter trauma cases; many don’t accept 911 ambulance runs. The purpose of this study is to characterize which services are consulted and how their response time affects length of ED stay and patient outcomes.
METHODS: The West Haven VA ED is a Level I facility staffed by a combination of board-certified emergency physicians, internists and staff nurses. It had >11,000 patient encounters during the previous year and is the main source of admissions to the hospital. Here we analyze a randomly selected sample of almost 1000 pages to the ED between the months of January and July of 2014.
RESULTS: A total of 6835 encounters occurred in the ED and 1411 patients were admitted. Between the 4 pm and midnight a higher proportion of evaluated patients were admitted (Fig 1). The median total time in minutes spent by patients in the ED was 469 if admitted and 184 if discharged. A total of 992 pages were recorded. 392 pages originated (Fig 2) from one of the authors who worked mainly during the second shift (4 pm to midnight). This subgroup was further analyzed. Those who required at least one page spent more time in the ED than patients who did not (Fig 3A), and the time spent in the ED increased proportionally with the number of pages required (Fig 3B). An association was seen between the number of pages from the ED and mortality even when adjusted for age and unit disposition.
CONCLUSIONS: Paging services such as imaging or consultants from the emergency department has a significant effect on the amount of time patients spend in the ED. Response time varies widely among services and could provide an important QI target for EDs seeking to improve patient flow and satisfaction. In this study, the number of pages required from ED was associated with mortality (p<0.001) even after adjustment for age and unit disposition.
CLINICAL IMPLICATIONS: Improving the time response of consultant services to the ED should be considered a priority in our institution. Delay on time response could potentially lead to worse outcomes for both patients in the ED and patients admitted to the hospital.
DISCLOSURE: The following authors have nothing to disclose: Mario Perez
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