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Code Help: Can This Unique State Regulatory Intervention Improve Emergency Department Crowding?

Sean S Michael1,2, John P Broach1, Kevin A Kotkowski1

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Adhering to the Massachusetts Code Help policy for emergency departments (ED) reduced patient boarding times and length of stay (LOS). Violations of this policy, however, led to adverse effects on these critical care metrics.

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Area of Science:

  • Health Services Research
  • Hospital Administration
  • Emergency Medicine

Background:

  • Emergency department (ED) crowding negatively impacts patient care quality.
  • The Massachusetts Code Help policy mandates hospital action plans to mitigate ED boarding.
  • Inconsistent implementation of the Code Help policy has been observed.

Purpose of the Study:

  • To investigate the association between adherence to the Code Help policy and ED boarding time and total ED length of stay (LOS) for admitted patients.
  • To compare outcomes during periods of Code Help policy compliance and violation against normal operations.

Main Methods:

  • Retrospective analysis of electronic patient-care timestamps and a prospective Code Help registry.
  • Inclusion of consecutive adult patients admitted from the ED at a single academic center over 15 months.
  • Comparison of ED boarding time and ED LOS during policy compliance, violation, and normal operations.

Main Results:

  • Patients admitted during Code Help policy violations experienced significantly longer boarding times (median 20 minutes longer) and total ED LOS (median 46 minutes longer) compared to normal operations.
  • No significant increase in boarding time or ED LOS was observed for patients admitted during Code Help policy compliance compared to normal operations.
  • Analysis included 24,017 admitted patients out of 89,587 total ED presentations.

Conclusions:

  • Consistent implementation of the Massachusetts Code Help policy is associated with reduced ED boarding time and ED LOS.
  • Violations of the Code Help policy negatively impact ED boarding time and ED LOS.
  • This single-center study highlights the importance of consistent policy adherence for optimizing emergency care flow.