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Using emergency physicians' abilities to predict patient admission to decrease admission delay time.
Emerg Med J. 2020 Jul; 37(7):417-422.EM

Abstract

BACKGROUND

In many EDs, emergency physicians (EPs) do not have admitting privileges and must wait for consultants to further assess and admit patients. This delays bed requests and increases ED crowding. We measured EPs' abilities to predict patient admission prior to consultation and estimated the potential ED stretcher time saved if EPs requested a bed with consultation.

METHODS

We conducted a prospective cohort study in an academic centre in Canada between October 2017 and February 2018 using a convenience sample of ED patient encounters requiring consultation. We excluded patients under 18 years or those clearly likely to be admitted (traumas, strokes, S-T elevation myocardial infarctions and Canadian Triage and Acuity Scale of 1). EPs predicted patient admission just before consultation. Potential ED stretcher time saved was estimated for correctly predicted admissions assuming bed requests were initiated with consultation and a constant time to inpatient bed.

RESULTS

Characteristics of 454 patients were: mean age 60.1 years, 48.5% male, 46.9% evening presentation, 69.4% admitted and median time to bed request of 3.5 hours (IQR 2.0-5.3 hours). Overall, EPs prediction sensitivity, specificity, positive predictive value and negative predictive value were 90.5% (95% CI 86.7% to 93.5%), 84.2% (95% CI 77.0% to 89.8%), 92.8% (95% CI 89.8% to 95.0%) and 79.6% (95% CI 73.4% to 84.7%). Approximately 922.1 hours of ED stretcher time could have been saved during the 5-month study period if EPs initiated a bed request with consultation.

CONCLUSION

Crowding is a reality for EDs worldwide, and many systems could benefit from EP-initiated hospital admissions to decrease the amount of time admitted patients wait in the ED.

Authors+Show Affiliations

Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada ericlee@toh.ca.Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada.Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada. Department of Emergency Medicine, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32139515

Citation

Lee, Erica E M., et al. "Using Emergency Physicians' Abilities to Predict Patient Admission to Decrease Admission Delay Time." Emergency Medicine Journal : EMJ, vol. 37, no. 7, 2020, pp. 417-422.
Lee EEM, Kwok ESH, Vaillancourt C. Using emergency physicians' abilities to predict patient admission to decrease admission delay time. Emerg Med J. 2020;37(7):417-422.
Lee, E. E. M., Kwok, E. S. H., & Vaillancourt, C. (2020). Using emergency physicians' abilities to predict patient admission to decrease admission delay time. Emergency Medicine Journal : EMJ, 37(7), 417-422. https://doi.org/10.1136/emermed-2019-208859
Lee EEM, Kwok ESH, Vaillancourt C. Using Emergency Physicians' Abilities to Predict Patient Admission to Decrease Admission Delay Time. Emerg Med J. 2020;37(7):417-422. PubMed PMID: 32139515.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Using emergency physicians' abilities to predict patient admission to decrease admission delay time. AU - Lee,Erica E M, AU - Kwok,Edmund S H, AU - Vaillancourt,Christian, Y1 - 2020/03/05/ PY - 2019/06/24/received PY - 2020/01/09/revised PY - 2020/01/27/accepted PY - 2020/3/7/pubmed PY - 2020/3/7/medline PY - 2020/3/7/entrez KW - admission avoidance KW - emergency department KW - hospitalisations SP - 417 EP - 422 JF - Emergency medicine journal : EMJ JO - Emerg Med J VL - 37 IS - 7 N2 - BACKGROUND: In many EDs, emergency physicians (EPs) do not have admitting privileges and must wait for consultants to further assess and admit patients. This delays bed requests and increases ED crowding. We measured EPs' abilities to predict patient admission prior to consultation and estimated the potential ED stretcher time saved if EPs requested a bed with consultation. METHODS: We conducted a prospective cohort study in an academic centre in Canada between October 2017 and February 2018 using a convenience sample of ED patient encounters requiring consultation. We excluded patients under 18 years or those clearly likely to be admitted (traumas, strokes, S-T elevation myocardial infarctions and Canadian Triage and Acuity Scale of 1). EPs predicted patient admission just before consultation. Potential ED stretcher time saved was estimated for correctly predicted admissions assuming bed requests were initiated with consultation and a constant time to inpatient bed. RESULTS: Characteristics of 454 patients were: mean age 60.1 years, 48.5% male, 46.9% evening presentation, 69.4% admitted and median time to bed request of 3.5 hours (IQR 2.0-5.3 hours). Overall, EPs prediction sensitivity, specificity, positive predictive value and negative predictive value were 90.5% (95% CI 86.7% to 93.5%), 84.2% (95% CI 77.0% to 89.8%), 92.8% (95% CI 89.8% to 95.0%) and 79.6% (95% CI 73.4% to 84.7%). Approximately 922.1 hours of ED stretcher time could have been saved during the 5-month study period if EPs initiated a bed request with consultation. CONCLUSION: Crowding is a reality for EDs worldwide, and many systems could benefit from EP-initiated hospital admissions to decrease the amount of time admitted patients wait in the ED. SN - 1472-0213 UR - https://www.unboundmedicine.com/medline/citation/32139515/Using_emergency_physicians'_abilities_to_predict_patient_admission_to_decrease_admission_delay_time L2 - http://emj.bmj.com/cgi/pmidlookup?view=long&pmid=32139515 DB - PRIME DP - Unbound Medicine ER -
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