Abstract
Background: Holding admitted patients in the Emergency Department (ED) influences the length of stay, discharges, and the quality of care provided regardless of who is responsible for that situation. Purpose: To determine if transferring admitted patients holding in the ED to a dedicated inpatient nursing unit managed by ED staff would improve ED patient throughput and decrease Left Without Being Seen (LWBS). Methodology: The ED department opened an inpatient nursing unit for patients waiting for an inpatient bed. Prior to the unit opening, staff shadowed on an inpatient unit to enhance their knowledge of the inpatient unit patient care flow. Select admitted patients holding for inpatient beds were transferred to this unit until an inpatient bed was assigned. Inpatient orders were initiated once patients arrived in the unit. Results: Over nine months 11,115 patient care hours were transferred from the ED and helped with the bottle necking of patients in the ED. Patients who were transferred to the ED managed inpatient holding unit shared that they were so happy to get a private room with a bathroom, and that their families could stay with them while they waited for their inpatient bed assignment.
Highlights
It is commonly heard that some of main reasons the emergency department (ED) wait six to eight hours long because inpatient departments are short-staffed or do not expedite patient discharges
Over nine months 11,115 patient care hours were transferred from the Emergency Department (ED) and helped with the bottle necking of patients in the ED
Patients who were transferred to the ED managed inpatient holding unit shared that they were so happy to get a private room with a bathroom, and that their families could stay with them while they waited for their inpatient bed assignment
Summary
The largest population of boarders in the ED are patients who have been admitted but must wait in the ED on an inpatient bed to become available or assigned [2] This is problematic as the ED setting and staff are not equipped for or educated on implementing inpatient orders. In November of 2018, an emergency department at an urban hospital in the southeastern United States decided to prepare for the forthcoming increase in patient volume that is usually seen around the winter months. To be proactive for the increased ED and inpatient volume during the winter months, the ED director decided to turn a closed inpatient nursing unit into a new holding unit for patients that are admitted to the hospital and are waiting for an inpatient bed assignment. The location was picked due to its accessibility to the ED, via elevators just outside the ED, and the location was close to the inpatient nursing departments, so that moving patients is easier once they are assigned to an inpatient
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