Processes and impediments in moving patients from the emergency department: pilot study

To assess the impact of an ED-designed interim orders sheet on patient flow through the ED, and the safety of ED-directed admission.

The flow of patients through the ED and inpatient length of stay (IPLOS) was retrospectively reviewed on 135 patients who were admitted using interim orders and 125 patients who were admitted after inpatient unit review in the ED.

The median time to admission to the ward in the non-interim orders group was 5.7 h (interquartile range [IQR]: 3.8-8.5), with a range from 1.2 to 15.9 h, and in the interim orders group was 6.3 h (IQR: 4.8-8.0) with a range from 0.5 to 22 h (P=0.27). The median IPLOS was 4 days (IQR: 2.0-7.0) in the interim orders group, and 4 days (IQR: 2.1-9.0) in the non-interim orders group (P=0.19).

There was no difference in the time to patient admission, or IPLOS, with the different processes. Almost half of the average ED stay of adults and about one-third of that of paediatric admissions occurred after the decision to admit was made. Transfer of patients to the ward without inpatient review is appropriate and effective.