Abstract
Background: Express admit units (EAUs) have been proposed as a way to expedite patient
flow through the Emergency Department (ED). Objectives: We sought to determine the
effect of opening a five-bed EAU unit for temporary placement of admitted patients
on our ED length of stay (LOS) and waiting room times (WT). Method: This was a before-and-after
interventional study of the 3-month period immediately before (pre-EAU) and after
opening (post-EAU) of the EAU. We compared ED LOS and WT for patients admitted and
discharged from the ED for both time periods, controlling for daily census and patient
acuity. Results: During the post-EAU period, 386 patients (26.2% of total admits)
were admitted through the EAU. Overall LOS decreased from 8:21 (interquartile range
[IQR] 6:02–11:20) to 7:41 (IQR 5:22–10:16) for all admitted patients (p < 0.001), and from 3:41 (IQR 2:05–5:58) to 3:35 (IQR 2:00–5:55) for the discharged
patients (p = 0.025). After controlling for census and acuity, the LOS decreased an average of
10% (95% confidence interval [CI] 6%–14%; p < 0.001) for admitted patients and 4% (95% CI 2%–7%; p = 0.001) for discharged patients. These changes represented a decreased LOS of about
50 and 9 min, respectively. There were no significant differences in WT (0:44; IQR
0:09–2:07 vs. 0:50; IQR 0:11–2:20 for admitted patients and 0:41; IQR 0:09–1:50 vs.
0:41; IQR 0:10–1:47 for discharged patients). However, after controlling for census
and acuity, WT decreased 9% (95% CI 1%–16%; p = 0.022) for discharged patients, which represented a decrease of about 4 min. Conclusions:
With an EAU, there was a modest improvement in ED LOS despite an overall increase
in daily ED volume.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Emergency MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- National Hospital Ambulatory Medical Care Survey: 2005 emergency department summary.Adv Data. 2007; 386: 1-32
- Hospital-based emergency care: at the breaking point.National Academies Press, Washington, DC2006
- Waits to see an emergency department physician: U.S. trends and predictors, 1997–2004.Health Aff (Millwood). 2008; 27: w84-w95
- Emergency department overcrowding in the United States: an emerging threat to patient safety and public health.Emerg Med J. 2003; 20: 402-405
- Emergency department crowding.American College of Emergency Physicians, Irving, TX2008
- The use of an express admit unit to alleviate ED crowding [abstract].Ann Emerg Med. 2007; 50: S69
- Overcrowding in the nation's emergency departments: complex causes and disturbing effects.Ann Emerg Med. 2000; 35: 63-68
- The association between hospital overcrowding and mortality among patients admitted via western Australia emergency departments.Med J Aust. 2006; 184: 208-212
- Increase in patient mortality at 10 days associated with emergency department overcrowding.Med J Aust. 2006; 184: 213-216
- The opportunity loss of boarding admitted patients in the emergency department.Acad Emerg Med. 2007; 14: 332-337
- Strategies for dealing with emergency department overcrowding: a one-year study on how bedside registration affects patient throughput times.J Emerg Med. 2007; 32: 337-342
- Improving patient flow in an academic emergency department with a “team care” model.J Emerg Med. 2008; 34: 466
- Strategies to improve flow in the pediatric emergency department.Pediatr Emerg Care. 2007; 23: 745-749
- Emergency department overcrowding and ambulance diversion: the impact and potential solutions of extended boarding of admitted patients in the emergency department.J Emerg Med. 2006; 30: 351-356
- EMDOC (emergency department overcrowding) internet-based safety net research.J Emerg Med. 2008; 35: 101-107
- Rochester, New York: a decade of emergency department overcrowding.Acad Emerg Med. 2001; 8: 1044-1050
- The effect of hospital occupancy on emergency department length of stay and patient disposition.Acad Emerg Med. 2003; 10: 127-133
- Bridging orders and a dedicated admission nurse decreases emergency department turnaround times while increasing patient satisfaction.Ann Emerg Med. 2007; 50: 351-352
- A strategy to manage overcrowding: development of an ED holding area.J Emerg Nurs. 2004; 30: 237-242
- Emergency department census of patients awaiting admission following reorganization of an admissions process.Emerg Med J. 2006; 23: 363-367
- Effect of an emergency department (ED) managed acute care unit on ED overcrowding and emergency medical services diversion.Acad Emerg Med. 2001; 8: 1095-1100
- Impact of rapid entry and accelerated care at triage on reducing emergency department patient wait times, lengths of stay, and rate of left without being seen.Ann Emerg Med. 2005; 46: 491-497
Article info
Publication history
Published online: February 24, 2009
Accepted:
November 30,
2008
Received in revised form:
November 17,
2008
Received:
July 21,
2008
Identification
Copyright
© 2010 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
