Collaborative Among 42 U.S. Hospitals Improves Emergency Department Flow
Article Featured in December 2015 Issue of
The Joint Commission Journal on Quality and Patient Safety
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(OAK BROOK, Illinois, November 24, 2015) – Joint Commission Resources, Inc. today released the December 2015 issue of The Joint Commission Journal on Quality and Patient Safety, featuring an article on an 18-month collaborative among 42 U.S. hospitals across 16 communities to improve emergency department (ED) flow from October 2010 through March 2012.
The article, “Increasing Throughput: Results from a 42-Hospital Collaborative to Improve Emergency Department Flow,” by Mark S. Zocchi, MPH, senior research associate, George Washington University School of Medicine and Health Sciences, Washington, D.C., and colleagues, evaluated hospitals participating in a collaborative through the Aligning Forces for Quality (AF4Q) program. Each hospital identified one or more interventions to improve ED flow and submitted data on four related measures: (1) discharged length of stay (LOS), (2) admitted LOS, (3) boarding time, and (4) left without being seen (LWBS).
As a result of the collaborative, a total of 172 interventions were implemented. Two-thirds of the hospitals demonstrated improvement on at least one measure of ED flow. Among these hospitals, the average reduction in discharged LOS was 26 minutes, admitted LOS 36.5 minutes and boarding time 20.9 minutes. In addition, LWBS rates decreased by 1.4 absolute percentage points.
The authors conclude that successful approaches to ED flow improvement require certain fundamental elements, including engaged leadership, staff buy-in and sufficient resources. Even though most hospitals in the collaborative were able to improve on at least one measure of ED throughput, 14 hospitals did not demonstrate improvement. The authors assert that though CEO support was a requirement of initial enrollment, there was no requirement that the CEO or other corporate C-suite leadership be actively involved in the improvement teams, which may have stalled or even stopped some projects.
The remaining articles from the December 2015 issue are:
Timeliness and Efficiency
An Interdepartmental Care Model to Expedite Admission from the Emergency Department to the Medical ICU
Daniel J. Elliott, MD, MSCE, FACP, FAAP; Kimberly D. Williams, MPH; Pan Wu, PhD; Hemant V. Kher, PhD; Barret Michalec, PhD; Natalie Reinbold, BS, MA; Christian M. Coletti, MD, FAAEM, FACP; Badrish J. Patel, MD; Robert M. Dressler, MD, MBA
In an interdepartmental program, after patients were stabilized in the ED and identified as requiring medical intensive care unit (MICU) admission, the ED triggered the MICU Alert Team (MAT)—composed of a MICU nurse and physician assistant (with a MICU attending physician’s oversight). ED LOS was reduced by 30 percent (2.6 hours) from baseline (p < .001), with no significant differences in MICU or overall hospital LOS or mortality. ED LOS was shortened (p < .001) at each increasing level of MICU bed availability. A 1.5-hour drop in ED LOS (p = .02) for patients transferred from the MICU was sustained over time. These outcomes demonstrate that a MAT intervention can reduce ED LOS for critically ill patients.
The Well-Defined Pediatric ICU: Active Surveillance Using Nonmedical Personnel to Capture Less Serious Safety Events
William A. White, BA; Kelly Kennedy, BS; Holly S. Belgum, BS; Nathaniel R. Payne, MD; Stephen Kurachek, MD
An active surveillance program was created to identify less serious safety events (LSSEs). Premedical college graduates daily canvassed pediatric intensive care units and facilitated LSSE reporting at the point of care. Approximately 2,465 LSSEs, in addition to 541 serious safety events, were detected through the hospital’s Safety Learning Report system in a 15-month period. LSSEs resulted in a patient intervention 38 percent of the time and prompted 158 quality/safety improvement projects (74 completed).
Percent Time in Range with Warfarin as a Performance Measure: How Long a Sampling Frame Is Needed?
Adam J. Rose, MD, MSc, FACP; Joel I. Reisman, AB; Zayd Razouki, MD, MSc; Al Ozonoff, PhD
Percent time in therapeutic range (TTR) with warfarin is increasingly used as a performance measure. In a larger study on the impact of shortening the conventional measurement period for TTR, 124 sites within the U.S. Department of Veterans Affairs were examined between April 1, 2007 and September 30, 2014. Data were obtained on 295,237 unique patients receiving anticoagulation. Site mean TTR was highest when the most patients were included (6 months: 950 patients; TTR 65.2 percent), but the 3- and 4-month segments achieved similar results, each including more than 800 patients per site, with mean TTR of 64.9–65.2 percent. The authors recommend the use of a 4-month period for future measurement efforts.
Creating a Statewide Bed Tracker and Patient Registry to Communicate Bed Need and Supply in Emergency Psychiatry: The Maryland Experience
Patrick Triplett, MD; Suzanne D. Harrison, MPH; Steven R. Daviss, MD; Andrew F. Angelino, MD
Given the need to foster care coordination when hospitals are at risk for boarding of patients with psychiatric emergencies in EDs, an online registry for emergency psychiatry providers and inpatient psychiatric services was created in Maryland. After a slow start, participation in the bed registry expanded, only to ultimately dwindle. Future efforts should focus on secure, real-time communication channels that can accurately reflect supply and demand for psychiatric beds.