Abstract
Background
Physician consultation in the Emergency Department (ED) can account for a significant
portion of ED length of stay, which can lead to poor clinical outcomes.
Objective
The purpose of this study was to determine whether an institutional guideline could
lead to a reduction in time between consult request and admission decision. This guideline
codified a 90-min expected time interval to arrive and complete an admission disposition
where the consulting and admitting service were the same in an academic ED with weekly
audits and reports to departmental chairs and hospital administrators.
Methods
This was a study of consultation times of patients who presented to an academic ED
6 months before the adoption of an institutional guideline and 6 months after the
adoption of the guideline. Data measurement in both periods included the length of
time from ED consult order to admission disposition, time of ED discharge, number
of ED consultations (single and multiple), ED admissions, and the hospital discharge
time of admitted patients.
Results
Physician consult response time decreased from 121 min to 100 min (p < 0.0001), and patients left the ED 18 min earlier (p = 0.0221) after implementation of the consultation guideline despite more ED visits,
consultations, and admissions in the post-implementation time period. Patients were
discharged from the inpatient setting 50 min later (p < 0.0001) after implementation of the guideline.
Conclusion
An institutional guideline codifying timely ED consultations led to a significant
reduction in the time from ED consultation to admission disposition while also allowing
patients to leave the ED earlier in a high-occupancy academic medical center. However,
the discharge time of admitted hospital patients was later after implementation of
the guideline.
Keywords
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Article info
Publication history
Published online: February 01, 2013
Accepted:
November 3,
2012
Received in revised form:
July 31,
2012
Received:
March 22,
2012
Footnotes
Portions of this study were reported on December 14, 2011 to the University Health System Consortium's ED to Inpatient Improvement Collaborative: Improving ED Throughput by Addressing the Physician Consultation Process.
Identification
Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
