Effects of a hospital-wide intervention on emergency department crowding and quality: A prospective study

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dc.contributor.authorRichardson, Drew
dc.contributor.authorBrockman, Kate
dc.contributor.authorAbigail, Angela
dc.contributor.authorHollis, Greg
dc.date.accessioned2021-06-11T00:16:23Z
dc.date.issued2017
dc.date.updated2020-11-23T10:27:56Z
dc.description.abstractObjective: The objective of this study was to determine the impact of a management-supported, multimodal, hospital-wide intervention on ED crowding and quality measures. Methods: This is a prospective descriptive study of the first 20 weeks of the intervention, with 3 years of historical controls. The study was conducted in a 600 bed adult/paediatric tertiary hospital with 80 000 ED presentations annually. ED information system data were collected on all presentations in matched 20 week periods. Multiple interventions included ED Navigator role, ED Medical Staff teaming, corporate focus with key performance indicators and dashboards, appointment of a Director of Operations, Long Length of Stay Committee and reorganisation of the flow (bed management) unit. Process outcomes were 4 h performance as a proportion of all patients and mean daily length of crowding with more than 10 inpatients awaiting beds expressed as a time. Quality outcomes were proportions of patients who did not wait and who re-presented within 72 h. Results: there was a 9.1% increase in presentations and a 22.6% decrease in mean ED occupancy over the previous year. The 4 h performance improved from 56.1% (95% confidence interval [CI] 55.5–56.7) to 68.8% (95% CI 68.3–69.3) and daily crowding with more than 10 inpatients improved from 6:34 (95% CI 5:32–7:37) to 0:29 (95% CI 0:15–0:42). Did not wait improved significantly from 5.1 to 3.0% and rate of representation did not change. Conclusion: This prospective study shows significant improvement in ED flow without compromise in quality measures from a hospital-wide intervention requiring minimal additional resources. Further research is required on sustainability and patient outcomes beyond the ED.en_AU
dc.format.mimetypeapplication/pdfen_AU
dc.identifier.issn1742-6731en_AU
dc.identifier.urihttp://hdl.handle.net/1885/237271
dc.language.isoen_AUen_AU
dc.publisherBlackwell Publishing Ltden_AU
dc.rights© 2017 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicineen_AU
dc.sourceEmergency Medicine Australasiaen_AU
dc.source.urihttps://onlinelibrary.wiley.com/doi/full/10.1111/1742-6723.12771en_AU
dc.subjectcrowdingen_AU
dc.subjectemergency medicineen_AU
dc.subjectquality of healthcareen_AU
dc.titleEffects of a hospital-wide intervention on emergency department crowding and quality: A prospective studyen_AU
dc.typeJournal articleen_AU
local.bibliographicCitation.issue4en_AU
local.bibliographicCitation.lastpage420en_AU
local.bibliographicCitation.startpage415en_AU
local.contributor.affiliationRichardson, Drew, College of Health and Medicine, ANUen_AU
local.contributor.affiliationBrockman, Kate, Healthcare Reform Consultingen_AU
local.contributor.affiliationAbigail, Angela, Canberra Hospital and Health Servicesen_AU
local.contributor.affiliationHollis, Greg, The Canberra Hospitalen_AU
local.contributor.authoremailu4142446@anu.edu.auen_AU
local.contributor.authoruidRichardson, Drew, u4142446en_AU
local.description.embargo2099-12-31
local.description.notesImported from ARIESen_AU
local.identifier.absfor111709 - Health Care Administrationen_AU
local.identifier.ariespublicationa383154xPUB5736en_AU
local.identifier.citationvolume29en_AU
local.identifier.doi10.1111/1742-6723.12771en_AU
local.identifier.scopusID2-s2.0-85017277882
local.identifier.thomsonID000405922100007
local.identifier.uidSubmittedBya383154en_AU
local.publisher.urlhttps://onlinelibrary.wiley.comen_AU
local.type.statusPublished Versionen_AU

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