A Hospitalist‐Led Emergency Department Team Improves Hospital Bed Efficiency

1Denver Health and Hospital Authority, Denver, CO
2Denver Health and Hospital Authority, Denver, CO
3Denver Health and Hospital Authority, Denver, CO
4Denver Health and Hospital Authority, Denver, CO
5Denver Health and Hospital Authority, Denver, CO
6Denver Health and Hospital Authority, Denver, CO
7Denver Health and Hospital Authority, Denver, CO
8Denver Health and Hospital Authority, Denver, CO

Meeting: Hospital Medicine 2010, April 8-11, Washington, D.C.

Abstract number: 32

Background:

Admitted patients boarded in the emergency department (ED) leads to hospital diversion. Active bed management by hospitalists can improve throughput. Minimizing wasted patient movement and inappropriate bed utilization may improve throughput for hospitals routinely operating at near‐capacity. We developed a hospitalist‐led team to care for boarded, admitted ED patients in an effort to minimize unnecessary patient transfers and inappropriate bed utilization.

Methods:

On August 3, 2009, at an urban academic safety net hospital, a hospitalist‐led medicine ED Team was created to care for boarded admitted ED patients. These patients were cared for by this team until discharge from the ED or transfer to the medical floor. To assess the effect of the hospitalist‐led medicine ED Team, 2 makers of efficient patient movement and bed utilization were measured: (1) the proportion of patients discharged within 8 hours of transfer to a medical floor and (2) the proportion of patients admitted to medicine and discharged from the ED. These were compared pre‐ and postimplementation with the chi‐square test. To measure the effect of handoffs introduced by the creation of a hospitalist‐led medicine ED team, total length of stay for patients admitted to this team and handed off to a medicine floor was also assessed during the same period with the Student t test.

Results:

The hospitalist‐led medicine ED Team was able to reduce the percentage of patients transferred to a medicine floor and discharged within 8 hours from 1.5% to 0.5% (P < 0.01; Table 1). This team also increase the number of discharges from the ED of admitted medicine patients from 4.9% to 7.9% (P < 0.001; Table 1). Total length of stay for patients managed by this team and handed off to a medicine floor did not increase.

Conclusions:

A hospitalist‐led medicine ED team managing admitted medicine patients boarding in the ED can improve the utilization of hospital resources. Bed usage is maximized, as fewer patients are sent to inpatient beds only to be discharged within 8 hours, This team can also increase hospital throughput by facilitating the workup of boarded medicine patients, resulting in discharge and avoiding transfer to an inpatient bed. Despite introducing a handoff for boarded medicine patients transferred to the medical floor, this system does not increase length of stay.

Author Disclosure:

S. Chadaga, none; D. Mancini, none; P. Mehler, none; K. Heist, none; A. Keniston, none; S. VanDyke, none; E. Chu, none; K. Heade, none.

To cite this abstract:

Chadaga S, Mancini D, Mehler P, Heist K, Keniston A, Dyke S, Heade K, Chu E. A Hospitalist‐Led Emergency Department Team Improves Hospital Bed Efficiency. Abstract published at Hospital Medicine 2010, April 8-11, Washington, D.C. Abstract 32. Journal of Hospital Medicine. 2010; 5 (suppl 1). https://www.shmabstracts.com/abstract/a-hospitalistled-emergency-department-team-improves-hospital-bed-efficiency/. Accessed May 27, 2019.

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