ED "hold" patients: is their care also being held?

Area of Science:

• Healthcare Management
• Patient Care Standards
• Emergency Medicine

Background:

• Hospital care standards should be uniform across all locations.
• Limited data exists on care quality for admitted patients awaiting inpatient beds in the emergency department (ED).
• This study investigates potential disparities in care for pneumonia patients held in the ED versus those directly admitted.

Purpose of the Study:

• To compare the timeliness of nursing assessments and initial antibiotic administration for pneumonia patients.
• To evaluate adherence to standards of care for admitted patients experiencing ED "holds" versus direct admissions.

Main Methods:

• A descriptive comparative research design was employed.
• Two groups were compared: "ED hold" patients and "ED direct-admit" patients.
• A retrospective chart audit of 104 closed medical records from a Midwestern hospital was conducted.

Main Results:

• Patients on "ED hold" had vital signs (blood pressure, pulse, respiratory rate, oxygen saturation) recorded more frequently.
• Directly admitted patients had intake/output and temperature recorded more frequently.
• While respiratory assessments and antibiotic administration timeliness showed no significant difference, direct-admit patients received antibiotics 1 hour earlier on average.

Conclusions:

• Statistical differences exist in the frequency and timeliness of vital signs, intake/output recording, and antibiotic administration between "hold" and "direct-admit" patients.
• Some assessments were more timely for "ED hold" patients, but direct admissions received antibiotics sooner.
• Further investigation is required to assess other potential impacts on care quality for patients held in the ED.