A novel approach to improving emergency department consultant response times

Emergency department (ED) overcrowding is a threat to patient safety and public health. Availability of specialty consultation to the ED may contribute to overcrowding. We implemented a novel intervention using education, goal setting and real-time performance feedback to improve time to admission for patients referred to general internal medicine (GIM).

Using a time-series design, we examined the effects of a quality improvement intervention on ED wait-times in an academic medical centre. The multifaceted approach included a didactic session for GIM housestaff on medicine triage principles and methods; setting a goal to have disposition decisions and, where appropriate, admission order within 4 h of consultation request; and providing personal data feedback on their performance on this metric to GIM housestaff during their rotation on the inpatient teaching service over a 1-year period. We compared time from consultation request to disposition decision and overall ED length of stay (LOS) for all patients referred to GIM during the intervention period (February 2011-February 2012) with data from the control period (January 2010-January 2011).

Mean time from GIM consultation request to admission order entry decreased by 92 min (SD, 5, p<0.05) from 321min in the control period to 229 min in the intervention period. Overall ED LOS for GIM patients decreased by 59 min (SD, 14, p<0.05) for admitted patients from 1022 min in the control period to 963 min in the intervention period, and by 40 min (SD, 13, p<0.05) for all patients referred to GIM. GIM staffing and patient characteristics remained stable across the two periods.

ED throughput for admitted medical patients improved with a quality improvement initiative involving education, goal setting and performance feedback.