Prolonged emergency department boarding times have been associated with poor patient satisfaction, adverse clinical outcomes, longer hospital stays, increased ambulance diversion, reduction in the possibility of increased revenue from additional patient services, and increased opportunity loss. A Benchmark transition metric following disposition has been proposed by the members of the emergency department (ED) Performance Measures and Benchmarking Summit to be 120 minutes. This 2‐hour period would begin when the decision was made to admit a patient to the hospital (‘decision to admit time’) or at the time when an inpatient bed was first requested.
To develop and implement an intervention that improves ED treatment capacity and patient revenue while maintaining quality in patient care as well as patient satisfaction.
Two hospitals (HA, the referring hospital, and HB, the accepting hospital) located 1.3 miles from each other were used in this study. HA and HB belong to a health care system with a total of 11 hospitals. HA is a teaching institution, with 731 beds, 47,000 ED visits per year, and 7000 medical admissions. HB is also a teaching hospital with 230 beds and 33,000 ED visits per year. We developed a process to transfer patients from the HA ED to an inpatient bed in HB, followed by a hospitalist service. The transfer process to HB was initiated if all the following things happened first at HA: (1) a decision to admit a patient had been made, (2) the patient was evaluated and received initial treatment and was clinically stable, (3) no bed that fit patient needs was available, and (4) the patient consented to the transfer. Then, a phone call from the HA ED was made to the ambulance transfer service (ATS) at HA to initiate the transfer to HB. The ATS called the hospitalist service at HB. This service connected HA and HB, opening a line of communication. The patient was presented from HA to HB. If HB had availability that matched the request, then it confirmed the bed assignment to HA. The total process involved only 1 phone call and took an average of 3.5 minutes to be completed. Then we calculated the opportunity losses of inpatient boarding and admission process delays for HA
Without inpatient boarders to obstruct the normal cycle of bed turnover, the HA ED would potentially have regained enough functional capacity to accommodate another 1073 additional patient visits, an average of 2.9 patients a day. The program transferred 265 patients to HB, an average of 0.7 patients a day. This allowed HA to regain 3.8% of its functional capacity for medicine patients. Furthermore, the program represented a median net revenue of $520,000 and $1.9 million for HA and HB, respectively. In summary the transfer program allowed the ED in HA to regain treatment capacity by creating a new process for the health care system that optimized revenue without affecting patient care or satisfaction.
D. Martinez‐Vasquez ‐ none; M. Winters ‐ none; M. Harrington ‐ none
To cite this abstract:Martinez‐Vasquez D, Winters M, Harrington M. Oral: Improvement in Emergency Department Treatment Capacity: A Health System Integration Approach. Abstract published at Hospital Medicine 2011, May 10-13, Dallas, Texas. Abstract 1008. Journal of Hospital Medicine. 2011; 6 (suppl 2). https://www.shmabstracts.com/abstract/oral-improvement-in-emergency-department-treatment-capacity-a-health-system-integration-approach/. Accessed May 26, 2019.