Abstract
Introduction:We tested the effect of a brief disposition process intervention on residents’ time to disposition and emergency department (ED) length of stay (LOS) in high acuity ED patients.Methods:This was a quasi-experimental study design in a single teaching hospital where ED residents are responsible for administrative bed requests for patients. Enrollment was performed for intervention and control groups on an even-odd day schedule. Inclusion criteria were ED patients triaged as Emergency Severity Index (ESI) 1 and 2. In the intervention group, the attending physician prompted the resident to make the disposition immediately after the evaluation of resuscitation patients. In the control group, the attending physicians did not intervene in the disposition process unless more than 2 hours passed without a disposition. Main outcomes were time to disposition and total ED LOS.Results:A total of 104 patients were enrolled; 53 (51%) in the intervention group and 51 (49%) in the control group. After controlling for ESI and resident training year, mean disposition time was significantly shorter in the intervention group by 41.4 minutes (95% CI: 32.6–50.1). LOS was also shorter in the intervention group by 93.3 minutes (95% CI: 41.9–144.6).Conclusion:Prompting residents to enter administrative disposition orders in high acuity patients is associated with significant reduction in both time to disposition and ED LOS.
Highlights
We tested the effect of a brief disposition process intervention on residents’ time to disposition and emergency department (ED) length of stay (LOS) in high acuity ED patients
Prompting residents to enter administrative disposition orders in high acuity patients is associated with significant reduction in both time to disposition and ED LOS. [West J Emerg Med 2013;14(2):137-140.]
We found that a disposition process intervention where attending physicians prompt early bed request decision-making by residents was effective in reducing time to disposition and overall ED LOS
Summary
Prolonged length of stay in critically ill patients in the emergency department (ED) is associated with higher complication rates and higher mortality rates.[1,2] This is because often the focus of emergency care is on the initial management of patients (such as immediate resuscitation). Longer term management, such as managing ventilator settings and titrating medications, is sometimes deprioritized because of competing demands and expectation that those tasks will occur in the inpatient setting. One of the key steps in ED care is the Volume XIV, no. 2 : March 2013
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