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The Impact of Bed Traffic Control and Improved Flow Process on Throughput Measures in a Metropolitan Emergency Department.
J Emerg Nurs. 2020 Sep; 46(5):682-692.JE

Abstract

INTRODUCTION

ED crowding is a complex phenomenon that presents many challenges to patients, hospitals, and staff. Using Lewin's change model, we implemented an ED improvement plan, including an innovative bed traffic control and improved flow system. We hypothesized that this plan would reduce door-to-provider time and emergency medical service-offloading time, decrease the length of stay and number of patients leaving without being seen by a physician, and increase overall patient satisfaction.

METHODS

We examined the ED improvement plan's impact on institutional throughput metrics over a 4-year period (2015-2019). Data on door-to-provider time, door-to-discharge time, patient volume, leaving without being seen by a physician, and patient satisfaction by Press Ganey were analyzed.

RESULTS

Between 2015 and 2018, the median door-to-provider time decreased 56.9% and the median door-to-discharge time decreased 29.6%. Percentage of patients who left without being seen by a physician decreased 73.8%. In 2018, the patient satisfaction rank increased by 16 points (84.2% increase). Emergency medical services-offloading time decreased significantly, prompting a change of the 30-minute cutoff to 20 minutes. In 2018, 0.84% of patients had an offloading time of more than 20 minutes. Preliminary 2019 data show maintenance of this trend for all hospital metrics.

DISCUSSION

Implementing a pod system, with flow and bed placement managed by bed traffic control, reduced door-to-provider time, door-to-discharge time, leaving without being seen by a physician, emergency medical service-offload time, and increased patient satisfaction. Our results may provide a model for other emergency departments to effectively manage the challenges of crowding.

Authors

No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31955924

Citation

Stahley, Lorinda, et al. "The Impact of Bed Traffic Control and Improved Flow Process On Throughput Measures in a Metropolitan Emergency Department." Journal of Emergency Nursing, vol. 46, no. 5, 2020, pp. 682-692.
Stahley L, O'Brien PB, Lowe M, et al. The Impact of Bed Traffic Control and Improved Flow Process on Throughput Measures in a Metropolitan Emergency Department. J Emerg Nurs. 2020;46(5):682-692.
Stahley, L., O'Brien, P. B., Lowe, M., Porteous, P., & Austin, S. (2020). The Impact of Bed Traffic Control and Improved Flow Process on Throughput Measures in a Metropolitan Emergency Department. Journal of Emergency Nursing, 46(5), 682-692. https://doi.org/10.1016/j.jen.2019.10.019
Stahley L, et al. The Impact of Bed Traffic Control and Improved Flow Process On Throughput Measures in a Metropolitan Emergency Department. J Emerg Nurs. 2020;46(5):682-692. PubMed PMID: 31955924.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The Impact of Bed Traffic Control and Improved Flow Process on Throughput Measures in a Metropolitan Emergency Department. AU - Stahley,Lorinda, AU - O'Brien,Paul B, AU - Lowe,Matthew, AU - Porteous,Penny, AU - Austin,Sean, Y1 - 2020/01/16/ PY - 2018/09/21/received PY - 2019/10/23/revised PY - 2019/10/27/accepted PY - 2020/1/21/pubmed PY - 2021/5/11/medline PY - 2020/1/21/entrez KW - ED flow KW - ED redesign KW - Emergency medical services KW - Emergency severity index KW - Patient satisfaction KW - Triage SP - 682 EP - 692 JF - Journal of emergency nursing JO - J Emerg Nurs VL - 46 IS - 5 N2 - INTRODUCTION: ED crowding is a complex phenomenon that presents many challenges to patients, hospitals, and staff. Using Lewin's change model, we implemented an ED improvement plan, including an innovative bed traffic control and improved flow system. We hypothesized that this plan would reduce door-to-provider time and emergency medical service-offloading time, decrease the length of stay and number of patients leaving without being seen by a physician, and increase overall patient satisfaction. METHODS: We examined the ED improvement plan's impact on institutional throughput metrics over a 4-year period (2015-2019). Data on door-to-provider time, door-to-discharge time, patient volume, leaving without being seen by a physician, and patient satisfaction by Press Ganey were analyzed. RESULTS: Between 2015 and 2018, the median door-to-provider time decreased 56.9% and the median door-to-discharge time decreased 29.6%. Percentage of patients who left without being seen by a physician decreased 73.8%. In 2018, the patient satisfaction rank increased by 16 points (84.2% increase). Emergency medical services-offloading time decreased significantly, prompting a change of the 30-minute cutoff to 20 minutes. In 2018, 0.84% of patients had an offloading time of more than 20 minutes. Preliminary 2019 data show maintenance of this trend for all hospital metrics. DISCUSSION: Implementing a pod system, with flow and bed placement managed by bed traffic control, reduced door-to-provider time, door-to-discharge time, leaving without being seen by a physician, emergency medical service-offload time, and increased patient satisfaction. Our results may provide a model for other emergency departments to effectively manage the challenges of crowding. SN - 1527-2966 UR - https://www.unboundmedicine.com/medline/citation/31955924/The_Impact_of_Bed_Traffic_Control_and_Improved_Flow_Process_on_Throughput_Measures_in_a_Metropolitan_Emergency_Department_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0099-1767(19)30516-1 DB - PRIME DP - Unbound Medicine ER -