Decreasing emergency department wait times for available inpatient beds by removing artificial variation

Abstract

Study objectives: Because increasing emergency department (ED) census and crowding has become a substantial issue, initiatives to decrease waiting times for inpatient beds have become increasingly important. A proportion of the waiting done by patients in the ED is the result of artificial variation within the current system. We decrease the wait time (WAIT) from ED decision to admit (EDADMIT) to arrival on the unit (INUNIT) by system collaboration and novel protocol development. Methods: At our community-based hospital, the ED, inpatient nursing, and hospital administration collaborated to identify artificial variation within the admission process. Five initiatives were implemented, including an admission by appointment schedule, formation of a multidisciplinary bed occupancy committee, creation of an empowered bed operations supervisor position, establishment of a rapid diagnostic unit, and implementation of centralized telemetry. These initiatives were gradually and individually introduced into the hospital during a 6-month period ending in June 2003. Our primary outcome measure was the WAIT from EDADMIT to INUNIT for all patients who had a bed assigned. This measure was then calculated on the 3 floors: (1) a regular medical floor (RMF); (2) a telemetry floor (TELE); and 3) a coronary care unit (CCU). ED holds, patients who have been admitted to the hospital and yet stay in the ED because there is no bed available for them, were excluded because this would falsely elevate the WAIT. Data were collected before and after the interventions for 4 consecutive months and compared with that from the previous year. Results: Compared with the previous year's corresponding month, the average WAIT for the RMF decreased from 2.10 hours to 1.60 hours, representing a 25% improvement. The average WAIT for the TELE and CCU floors also showed a decrease of 36.2% and 44.9%, respectively. Conclusion: By identifying and decreasing artificial variation, a significant reduction in the time from EDADMIT to INUNIT can be achieved for patients with a bed assignment.