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Emergency department throughput: an intervention.

Nowreen Haq1, Rona Stewart-Corral2, Eric Hamrock3

  • 1Division of Hospital Medicine, Department of Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, MFL Bldg, West Tower 6th Floor, Baltimore, MD, 21224, USA.

Internal and Emergency Medicine
|January 17, 2018
PubMed
Summary
This summary is machine-generated.

Implementing a structured nursing protocol significantly reduced emergency department (ED) boarding time and increased early hospital discharges, improving overall hospital workflow and patient flow.

Keywords:
ED boarding timeEarly hospital dischargesHospital length of stayHospital workflow

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Area of Science:

  • Healthcare Management
  • Hospital Operations
  • Nursing Science

Background:

  • Emergency department (ED) boarding time and hospital bed capacity are critical challenges impacting healthcare systems.
  • Expediting inpatient discharge is essential for efficient hospital bed management and reducing patient wait times.

Purpose of the Study:

  • To evaluate the impact of a novel nursing intervention on hospital workflow, focusing on early inpatient discharges and ED boarding time.
  • To assess the effectiveness of a structured "admission discharge transfer" (ADT) protocol in managing patient flow.

Main Methods:

  • A prospective intervention study was conducted in a 38-bed academic hospital unit.
  • The study included 4486 patients, with 2259 receiving the ADT nursing intervention over 28 weeks.
  • Data on demographics, discharge timing, and ED boarding were collected and analyzed using Chi-square, t-tests, and Poisson regression.

Main Results:

  • The ADT intervention significantly reduced ED boarding time (p < 0.001).
  • Early hospital discharges (before 2 PM) significantly improved in the intervention group (p = 0.01).
  • A slight but significant reduction in length of stay was observed for observation patients, but not for inpatient admissions.

Conclusions:

  • Dedicated nursing resources for ED-boarded patients and early discharges can optimize hospital workflow.
  • The ADT protocol demonstrates potential for improving hospital efficiency and patient throughput.
  • Targeted nursing interventions are effective in addressing ED boarding and enhancing hospital bed management.