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Optimizing cardiology capacity to reduce emergency department boarding: a systems engineering approach.
Am Heart J. 2008 Dec; 156(6):1202-9.AH

Abstract

BACKGROUND

Patient safety and emergency department (ED) functionality are compromised when inefficient coordination between hospital departments impedes ED patients' access to inpatient cardiac care. The objective of this study was to determine how bed demand from competing cardiology admission sources affects ED patients' access to inpatient cardiac care.

METHODS

A stochastic discrete event simulation of hospital patient flow predicted ED patient boarding time, defined as the time interval between cardiology admission request to inpatient bed placement, as the primary outcome measure. The simulation was built and tested from 1 year of patient flow data and was used to examine prospective strategies to reduce cardiology patient boarding time.

RESULTS

Boarding time for the 1,591 ED patients who were admitted to the cardiac telemetry unit averaged 5.3 hours (median 3.1, interquartile range 1.5-6.9). Demographic and clinical patient characteristics were not significant predictors of boarding time. Measurements of bed demand from competing admission sources significantly predicted boarding time, with catheterization laboratory demand levels being the most influential. Hospital policy required that a telemetry bed be held for each electively scheduled catheterization patient, yet the analysis revealed that 70.4% (95% CI 51.2-92.5) of these patients did not transfer to a telemetry bed and were discharged home each day. Results of simulation-based analyses showed that moving one afternoon scheduled elective catheterization case to before noon resulted in a 20-minute reduction in average boarding time compared to a 9-minute reduction achieved by increasing capacity by one additional telemetry bed.

CONCLUSIONS

Scheduling and bed management practices based on measured patient transfer patterns can reduce inpatient bed blocking, optimize hospital capacity, and improve ED patient access.

Authors+Show Affiliations

Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21230, USA. slevin33@jhmi.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19033021

Citation

Levin, Scott R., et al. "Optimizing Cardiology Capacity to Reduce Emergency Department Boarding: a Systems Engineering Approach." American Heart Journal, vol. 156, no. 6, 2008, pp. 1202-9.
Levin SR, Dittus R, Aronsky D, et al. Optimizing cardiology capacity to reduce emergency department boarding: a systems engineering approach. Am Heart J. 2008;156(6):1202-9.
Levin, S. R., Dittus, R., Aronsky, D., Weinger, M. B., Han, J., Boord, J., & France, D. (2008). Optimizing cardiology capacity to reduce emergency department boarding: a systems engineering approach. American Heart Journal, 156(6), 1202-9. https://doi.org/10.1016/j.ahj.2008.07.007
Levin SR, et al. Optimizing Cardiology Capacity to Reduce Emergency Department Boarding: a Systems Engineering Approach. Am Heart J. 2008;156(6):1202-9. PubMed PMID: 19033021.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Optimizing cardiology capacity to reduce emergency department boarding: a systems engineering approach. AU - Levin,Scott R, AU - Dittus,Robert, AU - Aronsky,Dominik, AU - Weinger,Matthew B, AU - Han,Jin, AU - Boord,Jeffrey, AU - France,Daniel, Y1 - 2008/08/29/ PY - 2008/05/20/received PY - 2008/07/10/accepted PY - 2008/11/27/pubmed PY - 2008/12/17/medline PY - 2008/11/27/entrez SP - 1202 EP - 9 JF - American heart journal JO - Am Heart J VL - 156 IS - 6 N2 - BACKGROUND: Patient safety and emergency department (ED) functionality are compromised when inefficient coordination between hospital departments impedes ED patients' access to inpatient cardiac care. The objective of this study was to determine how bed demand from competing cardiology admission sources affects ED patients' access to inpatient cardiac care. METHODS: A stochastic discrete event simulation of hospital patient flow predicted ED patient boarding time, defined as the time interval between cardiology admission request to inpatient bed placement, as the primary outcome measure. The simulation was built and tested from 1 year of patient flow data and was used to examine prospective strategies to reduce cardiology patient boarding time. RESULTS: Boarding time for the 1,591 ED patients who were admitted to the cardiac telemetry unit averaged 5.3 hours (median 3.1, interquartile range 1.5-6.9). Demographic and clinical patient characteristics were not significant predictors of boarding time. Measurements of bed demand from competing admission sources significantly predicted boarding time, with catheterization laboratory demand levels being the most influential. Hospital policy required that a telemetry bed be held for each electively scheduled catheterization patient, yet the analysis revealed that 70.4% (95% CI 51.2-92.5) of these patients did not transfer to a telemetry bed and were discharged home each day. Results of simulation-based analyses showed that moving one afternoon scheduled elective catheterization case to before noon resulted in a 20-minute reduction in average boarding time compared to a 9-minute reduction achieved by increasing capacity by one additional telemetry bed. CONCLUSIONS: Scheduling and bed management practices based on measured patient transfer patterns can reduce inpatient bed blocking, optimize hospital capacity, and improve ED patient access. SN - 1097-6744 UR - https://www.unboundmedicine.com/medline/citation/19033021/Optimizing_cardiology_capacity_to_reduce_emergency_department_boarding:_a_systems_engineering_approach_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-8703(08)00617-0 DB - PRIME DP - Unbound Medicine ER -