Emergency Department Resources Research Articles

Trends and determinants of time spent in the emergency department among Australian hospital presenting self-harm cases

AimsWaiting time (WT) and length of stay (LOS) are important metrics used to assess service delivery in emergency departments (EDs), and have been associated with subsequent re-presentations in EDs. This study investigated socio-demographic and health service determinants of WT and LOS among hospital treated self-harm (SH) cases presenting to EDs in Australian based hospitals. MethodsThis study employed a retrospective cohort study of all SH cases (N=6203) presenting to public hospital EDs in the Western Sydney catchment area from January 2016 to December 2022. Cox proportional hazard models were used to analyse demographic and service factors related to WT and LOS in Australian hospitals along with a description of secular trends in WT and LOS. ResultsLonger WT was evident for patients aged 15-64 than 0-14 years, non-admitted patients and patients arriving at the ED via transport other than ambulance whereas longer LOS was associated with older patients (65+ years). The inflow of non-SH cases to the ED did not have an impact on WT or LOS among SH cases. WT and LOS increased over time, particularly post the onset of the COVID-19 pandemic. The number of current self-harm cases receiving treatment in ED at the time of patient’s arrival also increased WT and LOS. ConclusionsWT and LOS have increased, especially post the onset of the COVID-19 pandemic. These findings necessitate the urgent need for updated strategies to manage ED resources, and suggest initiatives relating to ED diversion where appropriate for patients presenting to hospital following SH.

Emergency Medical Services and Police Utilization for Pediatric Mental and Behavioral Health Concerns Within a Large Hospital System.

This study aimed to compare emergency medical services (EMS) and police utilization trends, epidemiology, and emergency department (ED) outcomes between pediatric patients with mental or behavioral health (MBH) emergencies and those with non-MBH concerns transported to a large children's hospital system. This was a retrospective cohort study of patients aged 5 to 18 years transported via EMS and police to two EDs affiliated with a children's hospital from January 2012 through December 2020. Data were abstracted from electronic hospital records. Encounters for MBH emergencies were identified using diagnostic codes and chief complaints. Trends of EMS and police transports of patients with MBH emergencies were examined. Patient demographics and ED outcomes were compared between children presenting with MBH emergencies and those with non-MBH concerns. During the 9-year study period, out of 40,663 transports to the EDs, 36,137 (89%) arrived via EMS, and 4,526 (11%) arrived via police. A total of 10,250 (28.4%) EMS transports were for MBH emergencies. The volume of patients transported by EMS for MBH emergencies increased by 1.4% per year (P < 0.01) with no significant change in total EMS patient volumes. Patients with MBH emergencies transported by EMS were more likely to be older, female, of White race, and publicly insured; require restraint in the ED; and be admitted (P < 0.001). Of police transports, 4153 (91.8%) were for MBH emergencies, with no statistical change in the proportion of police transports that were for MBH emergencies. Police-transported MBH patients compared to non-MBH police-transported patients were more likely to be younger, female, and of White race (P < 0.001); 8.7% required mechanical/physical restraints in ED, 6.7% required pharmacologic restraint medications in ED, and 53% were admitted. The proportion of pediatric transports for MBH emergencies by EMS is rising and comprises the majority of police transports. Distinct from non-MBH pediatric patients transported, MBH patients necessitate significant ED resources, including ED-administered restraints and admission, highlighting their unique burden on the prehospital and ED systems.

The role of emergency medicine specialists and general practitioners in yellow zone patient management: A case in the Sakarya Province

AbstractBackgroundEmergency departments in Turkey employ both emergency medicine specialists (EMSs) and general practitioners due to an insufficient number of EMSs. Patients are triaged into green, yellow, and red codes based on urgency. Typically, EMSs manage more critical patients (yellow and red codes), while general practitioners handle less urgent cases (green codes).ObjectiveThis study investigates differences in patient management approaches between EMSs and general practitioners in the yellow zone of an emergency department in the Sakarya Province.MethodThis retrospective, cross‐sectional study was conducted at the Sakarya Training and Research Hospital from 31 December 2020 to 31 December 2021. The study included patients aged 18 and older who were assigned to the yellow zone and discharged by the attending physician. Data on patient monitoring times, consultation requests, hospitalization rates, resource utilization, readmission rates, and hospital revenue contributions were collected and analyzed. Statistical analyses were performed using IBM SPSS version 21, comparing the performance of EMSs and general practitioners.ResultThe study included 59 physicians (14 EMSs and 45 general practitioners) and a large number of patients. EMSs had significantly more experience, shorter consultation request times, and higher ICU admission rates. They also ordered fewer MRIs and USGs per patient and made more consultation requests. There was no significant difference between EMSs and general practitioners in terms of the number of examinations, patient observation times, ward hospitalization rates, CT orders, readmission rates, and hospital revenue contributions.ConclusionEMSs demonstrated more efficient use of emergency department resources, effective consultation processes, and higher ICU admission rates, indicating better patient management. Despite the limited scope of this single‐center study, the findings highlight the importance of EMSs in improving emergency care quality. Further research is needed to validate these results across multiple centers.

Prediction of emergency department presentations for acute coronary syndrome using a machine learning approach

The relationship between weather and acute coronary syndrome (ACS) incidence has been the subject of considerable research, with varying conclusions. Harnessing machine learning techniques, our study explores the relationship between meteorological factors and ACS presentations in the emergency department (ED), offering insights into seasonal variations and inter-day fluctuations to optimize patient care and resource allocation. A retrospective cohort analysis was conducted, encompassing ACS presentations to Dutch EDs from 2010 to 2017. Temporal patterns were analyzed using heat-maps and time series plots. Multivariable linear regression (MLR) and Random Forest (RF) regression models were employed to forecast daily ACS presentations with prediction horizons of one, three, seven, and thirty days. Model performance was assessed using the coefficient of determination (R²), Mean Absolute Error (MAE), and Mean Absolute Percentage Error (MAPE). The study included 214,953 ACS presentations, predominantly unstable angina (UA) (94,272; 44%), non-ST-elevated myocardial infarction (NSTEMI) (78,963; 37%), and ST-elevated myocardial infarction (STEMI) (41,718; 19%). A decline in daily ACS admissions over time was observed, with notable inter-day (estimated median difference: 41 (95%CI = 37–43, p = < 0.001) and seasonal variations (estimated median difference: 9 (95%CI 6–12, p = < 0.001). Both MLR and RF models demonstrated similar predictive capabilities, with MLR slightly outperforming RF. The models showed moderate explanatory power for ACS incidence (adjusted R² = 0.66; MAE (MAPE): 7.8 (11%)), with varying performance across subdiagnoses. Prediction of UA incidence resulted in the best-explained variability (adjusted R² = 0.80; MAE (MAPE): 5.3 (19.1%)), followed by NSTEMI and STEMI diagnoses. All models maintained consistent performance over extended prediction horizons. Our findings indicate that ACS presentation exhibits distinctive seasonal changes and inter-day differences, with marked reductions in incidence during the summer months and a distinct peak prevalence on Mondays. The predictive performance of our model was moderate. Nonetheless, we obtained good explanatory power for UA presentations. Our model emerges as a potentially valuable supplementary tool to enhance ED resource allocation or future predictive models predicting ACS incidence in the ED.

246EMF Using Design Thinking and Community Advisors to Improve Emergency Department Resources for Intimate Partner Violence Survivors

246EMF Using Design Thinking and Community Advisors to Improve Emergency Department Resources for Intimate Partner Violence Survivors

Emergency department service utilisation of older patients with urgent conditions: a cross-sectional observational study

BackgroundAs with many countries worldwide, Singapore is experiencing a rapidly ageing population. Presentation of older persons for urgent but non-emergent conditions to the Emergency Department (ED) represents a growing group of patients utilising public healthcare emergency services and puts a strain on current ED resources. The medical conditions vary, and resources used has been poorly characterized.MethodsThis is a single-center cross-sectional observational study of patients aged 55 to 75 years old who visited the ED with urgent conditions, Patient Acuity Category Scale (PACS) P2 or P3, who were subsequently discharged. The patients visited a public hospital in Singapore on four randomly selected weekdays in April 2023. The utilisation of hospital resources and manpower was studied. A formulated criteria was used to determine the appropriate site of care, such as an Urgent Care Centre (UCC), Primary Care Providers (PCP) clinic or the ED.ResultsThere were 235 eligible patients during the study period, with a mean age of 65.1 years of which a majority, 183 (77.9%) were allocated to patient acuity category scale P2. Most of the patients were walk-in patients with no referrals (169 (71.9%)). Based on the criteria, the majority of 187 (79.6%) of these patient may be safely managed at an outpatient setting; 71 (30.2%) patients by PCP, 116 (49.4%) patients may be managed by an UCC, with the remaining 48 (20.4%) requiring ED care.ConclusionOur findings indicate that a significant portion of discharged older ED adults with urgent but non-emergent conditions may be adequately managed at outpatient medical services that are appropriately resourced. More research is needed on healthcare initiatives aimed at developing the capabilities of outpatient medical services to manage mild to moderate acute conditions to optimise ED resource allocation.

Healthcare professionals perceptions towards the determinants of effective emergency health care services in public health centres of Addis Ababa, Ethiopia

IntroductionEmergency healthcare services enable early detection and life-saving interventions for time-sensitive acute injuries and illnesses. The aim of this paper was to assess health care professional's perception towards determinants of effective emergency healthcare services in public health centers of Addis Ababa, Ethiopia, in 2023. MethodsA facility-based cross-sectional study was conducted at public health centers in Addis Ababa with a sample of 422 study participants. Study participants were selected using simple random sampling techniques. To identify factors associated with the outcome variable, bi-variable and multi-variable logistic regression analyses were conducted. Variables having a p-value less than 0.05 in multi-variable logistic regression analysis were declared determinants of positive perception towards emergency medical services effectiveness. ResultsAmong the study participants, 76.3 % (95 % CI: 72.3, 80.6) had a positive perception towards the public health centers effectiveness in providing emergency healthcare services. Moreover, training (AOR: 4.05; 95 % CI: 1.97, 8.32), ICT service implementation (AOR: 6.55; 95 % CI: 3.37, 12.73), resource availability in the emergency department (AOR: 5.07; 95 % CI: 2.51, 10.25), and management support (AOR: 3.22; 95 % CI: 1.66, 6.25) were determinant factors associated with the perception of effectiveness in emergency medical care services. ConclusionNearly three-fourths of healthcare providers in Addis Ababa perceived that the emergency healthcare services were effective. Furthermore, training on patient service delivery, ICT service implementation, availability of resources in emergency departments, and management support were independent determinants of positive perception towards effective emergency healthcare services.

Obstacles and Challenges Affecting Quality Indicators in a Complex Tertiary Emergency Center.

Hospital performance is significantly affected by external factors (political and economic) rather than internal factors (effectiveness and efficiency). Emergency department (ED) overcrowding is a significant issue for emergency care services globally, characterized by a rising number of visits and persistent unsolved issues, resulting in increased challenges faced by ED staff and decreased patient satisfaction. This study aimed to explore the obstacles and challenges that cause variation in ED quality indicators (QIs) based on five domains: infrastructure, population, workflow, workforce, and administration. A tertiary emergency center in Saudi Arabia administered a questionnaire with standardized measures to 180 nurses, using a cross-sectional descriptive design. Most nurses (75.5%) believed that crowded waiting rooms in the ED were the most influential factor affecting QIs. Many other challenges were identified, including bed capacity, triage area/workflow, increased volume during peak periods, demand for nonemergency visits, staff and shortages. Significant differences in nurses' responses were found on the basis of education level (for infrastructure only, p = 0.004), specialty (for nursing administration only, p = 0.052), and ED experience (for all variables, p = 0.008-0.039). The analysis uncovered various critical aspects of infrastructure, workflow, population, workforce, and nursing administration that have a major effect on patient flow in the ED. Comprehending these aspects will greatly affect the quality measures of ED performance and assist policymakers in formulating strategic plans to enhance ED performance. Therefore, successful implementation and optimization of ED resources depend greatly on considering the right decision variables and resource restrictions.

Growing burden of gamma-hydroxybutyrate intoxication on emergency department resource utilisation.

Recreational gamma-hydroxybutyrate (GHB) use is rising in Australia. We aimed to describe ED presentation patterns related to GHB over time and the impact this has on ED resource use. Retrospective review of prospective data collection from two clinical toxicology units based in Queensland and New South Wales. There were 751 GHB-related presentations to the two units (Newcastle, 127; Princess Alexandria, 624), with marked increases in presentations occurring in 2019 and 2023. The major intervention was intubation, with 95 (13%) patients intubated. GHB presentations to ED are rising and the impact on acute bed space and clinical resources is significant.

Development of a Complex Care Transition Team to Improve the Transition of Patients With Complex Care Needs to the Community.

Health care systems have historically struggled to provide adequate care for patients with complex care needs that often result in overuse of hospital and emergency department resources. Patients with complex care needs generally have increased expenses, longer length of hospital stays, an increased need for care management resources during hospitalization, and high readmission rates. Mayo Clinic in Arizona aimed to ensure successful transitions for hospitalized patients with complex care needs to the community by developing a complex care transition team (CCTT) program. With typical care management models, patients are assigned to registered nurse case managers and social workers according to the inpatient nursing unit rather than patient care complexity. Patients with complex care needs may not receive the amount of time needed to ensure an efficient and effective transition to the community setting. Furthermore, after transitioning to the community, patients with complex care needs often do not have access to care management resources if further care coordination needs arise. Acute care hospital in the US Southwest. The CCTT was composed of a registered nurse case manager, social worker, and care management assistant, with physician advisor support. The CCTT followed patients with complex care needs during their hospitalization and transition to the community for 90days after discharge. The number of inpatient admissions and hospital readmission rates were compared between 6months before and after enrollment in the CCTT program. Cost savings for decreased hospital length of stay, emergency department visits, and hospital readmissions were also determined. The CCTT selected patients according to a complex care algorithm , which identified patients who required high use of the health care system. The CCTT then followed this cohort of patients for an average of 90days after discharge. A total of 123 patients were enrolled in the CCTT program from July 1, 2019, to April 30, 2021, and 80 patients successfully graduated from the program. Readmission rates decreased from 51.2% at 6months before the intervention to 22.0% at 6months after the intervention. This reduced readmission rate resulted in a cost savings of more than $1 million. The outcomes resulting from implementation of the multidisciplinary CCTT highlight the need for a patient-specific approach to transitioning care to the outpatient setting. The patient social determinants of health that often contributed to overuse of health care resources included poor access to outpatient specialists, difficulty navigating the health care system due to illness or poor health literacy, and limited social support. The success of the CCTT program prompted the implementation of other specialty-specific pilot programs at Mayo Clinic in Arizona. The investment of time and resources, including dedicated personnel to follow patients with high hospital service usage, allows health care systems to reduce emergency department visits and hospital admissions and to provide patients with the best opportunity for success as they transition from the inpatient to outpatient setting.

Triage Discordance in an Academic Pediatric Emergency Department and Disparities by Race, Ethnicity, and Language for Care.

Minoritized patients are disproportionately represented in low-acuity emergency department (ED) visits in the United States in part caused by lack of timely access to primary and urgent care. However, there is also the possibility that implicit bias during triage could contribute to disproportionate representation of minority groups in low-acuity ED visits. Triage discordance, defined as when ED resources used are different from initial triage score predictions, can be used as a proxy for triage accuracy. Recent data suggest that discordant triage may be common, although little is known about the interaction with race, ethnicity, and language for care. This study aims to determine the prevalence of discordant triage among moderate- and low-acuity pediatric ED encounters and the interaction with patient race, ethnicity, and language for care. We performed a retrospective analysis of pediatric ED encounters from 2019 with Emergency Severity Index (ESI) scores of 3, 4, or 5 at an academic referral hospital. The primary outcome was triage discordance, encompassing overtriage (ESI 3 and 4) and undertriage (ESI 4 and 5). Logistic and multinomial regressions were used to assess discordant triage by race, ethnicity, and language group. Triage discordance occurred in 47% (n = 18,040) of encounters. Black and Hispanic patients had higher likelihood of undertriage for ESI 5 (adjusted odds ratio 1.21, 95% confidence interval [CI] 1.01-1.46 and 1.27, 95% CI 1.07-1.52, respectively), and Black patients were more likely to be overtriaged in ESI 3 (1.18, 95% CI 1.09-1.27). Those with a language other than English for care had higher proportions of overtriage for ESI 3 (1.08, 95% CI 1.04-1.12) and undertriage for ESI 5 (1.23, 95% CI 1.11-1.37). We found high rates of triage discordance in our pediatric ED, with significant associations with race, ethnicity, and language for care. Future research should evaluate the source of triage discordance and develop quality improvement efforts to improve equitable care.

The COVID-19 impact on STEMI disparities

ST-segment elevation myocardial infarction (STEMI) is a significant source of morbidity and mortality. Despite guideline-driven management and increased awareness of social determinants of health, there are persistent disparities in diagnosis, management, and outcomes. The coronavirus disease 2019 (COVID-19) pandemic has greatly affected emergency department visitation, conditions and throughput. The aim of this study was to find any potential health disparities in patients who presented with STEMI during the COVID-19 pandemic by reviewing STEMI care data from April to September 2019 (pre-pandemic) and April to September 2020 (during the pandemic) for our hospital system.Patients with STEMI within 12 h of presentation were included in this study, and subdivided by age, gender, and race/ethnicity. We compared the turnaround times between emergency department arrival to intervention (electrocardiogram or catheterization) within the patient subgroups to find any notable differences. No statistically significant changes in turnaround times during either study period were found based on age, gender, or race/ethnicity for the STEMI interventions despite shifts in emergency department resources during the pandemic. This study helped assess the status quo in STEMI intervention for our health system and serves as a baseline for us to monitor gaps in care or areas of improvement. As healthcare systems institute new measures to promote equitable care, such as improving the accuracy of demographic data capture, establishing a baseline is an essential first step in evaluating the impact of these measures.

Unveiling the patterns: exploring social and clinical characteristics of frequent mental health visits to the emergency department-a comprehensive systematic review.

Frequent presenters (FPs) are a group of individuals who visit the hospital emergency department (ED) frequently for urgent care. Many among the group present with the main diagnosis of mental health conditions. This group of individual tend to use ED resources disproportionally and significantly affects overall healthcare outcomes. No previous reviews have examined the profiles of FPs with mental health conditions. This study aims to identify the key socio-demographic and clinical characteristics of patients who frequently present to ED with a mental health primary diagnosis by performing a comprehensive systematic review of the existing literature. PRISMA guideline was used. PubMed, PsycINFO, Scopus and Web of Science (WOS) were searched in May 2023. A manual search on the reference list of included articles was conducted at the same time. Covidence was used to perform extraction and screening, which were completed independently by two authors. Inclusion and exclusion criteria were defined. The abstracts of 3341 non-duplicate articles were screened, with 40 full texts assessed for eligibility. 20 studies were included from 2004 to 2022 conducted in 6 countries with a total patient number of 25,688 (52% male, 48% female, mean age 40.7years old). 27% were unemployed, 20% married, 41% homeless, and 17% had tertiary or above education. 44% had a history of substance abuse or alcohol dependence. The top 3 diagnoses are found to be anxiety disorders (44%), depressive disorders (39%) schizophrenia spectrum and other psychotic disorders (33%). On average, FPs are middle-aged and equally prevalent in both genders. Current data lacks representation for gender-diverse groups. They are significantly associated with high rates of unemployment, homelessness, lower than average education level, and being single. Anxiety disorder, depressive disorder, and schizophrenia spectrum disorders are the most common clinical diagnoses associated with the group.

Best Practices for Treating Blind and Visually Impaired Patients in the Emergency Department: A Scoping Review.

Blind and visually impaired individuals, an under-represented population of the emergency department (ED), possess comorbidities and have a higher chance of in-hospital sequelae, including falls. This potentially vulnerable population, if not treated mindfully, can be subject to decreased quality of care, recurrent and/or longer hospitalizations, persistence of health issues, increased incidence of falls, and higher healthcare costs. For these reasons, it is crucial to implement holistic practices and train clinicians to treat blind and visually impaired patients in the ED setting. We identified and used a comprehensive article describing best practices for the care of blind and visually impaired patients to establish the ED-specific recommendations presented in this paper. A scoping review of the literature was then performed using PubMed to identify additional articles to support each recommendation. To ensure that recommendations could be implemented in a representative, scalable, and sustainable manner, we consulted an advocate for the blind to help refine and provide additional suggestions. We identified 14 recommendations that focus on communication strategies, ED resource access, and continuity of care. The main recommendation is for the clinician to support the unique healthcare needs of the visually impaired individual and maintain the patient's autonomy. Another recommendation is the consistent use of assistive devices (eg, canes, guide dogs) to aid patients to safely ambulate in the ED. Also identified as best practices were discharge education with the use of a screen reader and timely follow-up with a primary care physician. While we summarize a variety of recommendations in this article, it is important to implement only the strategies that work best for the patients, personnel, and environment specific to your ED. After implementation, it is vital to refine (as frequently as needed) the interventions to optimize the strategies. This will enable the provision of exceptional and equal care to blind and visually impaired patients in the ED.

Socially vulnerable patients are more likely to fail outpatient management of symptomatic cholelithiasis

BackgroundSymptomatic cholelithiasis is a common surgical problem, with many patients requiring multiple gallstone-related emergency department (ED) visits before cholecystectomy. The Social Vulnerability Index (SVI) identifies vulnerable patient populations. This study aimed to assess the association between social vulnerability and outpatient management of symptomatic cholelithiasis. MethodsPatients with symptomatic cholelithiasis–related ED visits were identified within our health system from 2016 to 2022. Clinical outcomes data were merged with SVI census track data, which consist of 4 SVI subthemes (socioeconomic status, household characteristics, racial and ethnic minority status, and housing type and transportation). Multivariate analysis was used for statistical analysis. ResultsA total of 47,292 patients presented to the ED with symptomatic cholelithiasis, of which 6103 patients (13.3 %) resided in vulnerable census tract regions. Of these patients, 13,795 (29.2 %) underwent immediate cholecystectomy with a mean time to surgery of 35.1 h, 8250 (17.4 %) underwent elective cholecystectomy at a mean of 40.6 days from the initial ED visit, and 2924 (6.2 %) failed outpatient management and returned 1.26 times (range, 1–11) to the ED with recurrent biliary–related pain. Multivariate analysis found social vulnerability subthemes of socioeconomic status (odds ratio [OR], 1.29; 95 % CI, 1.09–1.52) and racial and ethnic minority status (OR, 2.41; 95 % CI, 2.05–2.83) to be associated with failure of outpatient management of symptomatic cholelithiasis. ConclusionSocially vulnerable patients are more likely to return to the ED with symptomatic cholelithiasis. Policies to support this vulnerable population in the outpatient setting with timely follow-up and elective cholecystectomy can help reduce delays in care and overutilization of ED resources.

Emergency department resource utilization among nursing home residents, a National Cross-Sectional Study

ObjectivesPersons 65 years and older (older persons), particularly residents of nursing homes (NHs), disproportionately access the emergency department (ED) and utilize more medical resources. The goal of this study is to provide a contemporary description of healthcare utilization patterns and disposition decisions for United States (US) NH residents presenting to EDs. MethodsOlder persons presenting to EDs in the US were identified in the National Hospital Ambulatory Medical Care Survey (NHAMCS) 2017, 2018 and 2019 datasets. We examined demographic, clinical, and resource use characteristics and outcomes. After survey weighting, we compared the frequency of different imaging, medications, clinical interventions, and outcomes in the ED between NH residents and those residing outside NHs. ResultsFrom 2017 to 2019, older persons made 24,441,285 annual visits to the ED, comprising 17.5% of all visits. Among these, 1,579,916 visits (6.5%) were by NH residents. Compared with non-NH residents, NH residents were older (mean age: 81.2 [95%CI 81.5–82.9] vs 76.1 [95%CI 75.8–76.4]), underwent more imaging (82.8% [95%CI 79.5–86.1] vs 71.6% [95%CI 69.9–73.3]), were administered fewer potentially inappropriate medications (PIMs) in the ED or upon discharge (9.5% [95%CI 6.2–2.7] vs 17.1% [95%CI 15.8–18.4]), and had a higher proportion of visits resulting in hospital admission (44.1% [95% CI 38.2–49.9] vs 26.0% [95%CI 23.3, 28.7]). ConclusionsOlder NH residents presenting to the ED use more resources and are more likely to be hospitalized compared to older persons residing outside NHs. The resource-intensive nature of these visits highlights the importance of targeted, multi-disciplinary interventions that optimize ED care for this population.

Association between physician resource utilization, throughput, and patient experience in the emergency department

Background and Importance: Emergency department (ED) care is complex, involving multifaceted factors such as patient volume, provider experience, throughput metrics, and patient-provider interactions. While some studies have explored relationships between these parameters, there is still much to understand about the nuances in ED care. Objective: Our study aimed to analyze the statistical relationships between admission rates, Press Ganey (PG) scores, and various throughput/resource utilization variables in the ED. These variables include imaging and lab ordering rates, door-to-doctor (D2D) success rate, disposition times for specific patient acuities, and elopement or discharge against medical advice (AMA) rates. Design: A retrospective cohort study was conducted using data from eight emergency facilities within the Valley Health System. Settings and Participants: Data from six community hospital EDs and two freestanding emergency departments (FEDs) in the Valley Health System, spanning August 1, 2020, to July 31, 2021, were examined. The analysis involved 99 physicians and approximately 200,000 adult patients. Outcome Measures and Analysis: Correlations between admission rates, PG scores, and various ED metrics were examined using the Jamovi software. Separate analyses were conducted based on facility type using ANOVAs. Main Results: Our findings revealed several significant correlations. There was a positive correlation between lab ordering and admission rates, while D2D success rates showed a negative correlation with admission rates. Additionally, there was a positive association between D2D success rates and quick dispositioning of lower acuity patients. Patient satisfaction (PG score) was negatively correlated with admission, AMA, and D2D success rates, whereas it positively correlated with lab ordering rates. Conclusion: This study identifies significant relationships among ED throughput, resource utilization, and patient satisfaction metrics. These findings can guide further research to understand the patient experience better, optimize resource utilization, and improve overall ED efficiency.

Emergency care visits at a South African hospital: Implications for healthcare services and policy.

A robust knowledge on the pattern of use of emergency care resources not only serves as an indicator of universal access to care but also provides a basis for quality improvement within the health system. This study was undertaken to describe the pattern of emergency room visits at Brits District Hospital (BDH) in North West province, South Africa. The objectives of this study were to determine the sociodemographic characteristics of emergency department (ED) users and other patterns of ED use. This was a cross-sectional descriptive study that was conducted at a district hospital. All patients who reported for emergency care in the ED in 2016 were eligible for the study. Data were extracted and analysed from a systematic sample of 355 clinical notes and hospital administrative records. The age group that visited the ED most frequently (25.3%) was 25-34 years old. A high proportion of the ED users (60%) were self-referred, and only 38% were transported by the emergency medical response services (EMRS). Few (5.6%) presentations were of a non-urgent nature. Trauma-related conditions accounted for the most frequent presentation at the ED (36.5%). Although most ED users were self-referred, their clinical presentations were appropriate and underscore the need for policy strategies to reduce the burden of trauma in the catchment populationContribution:The study findings may have an impact on future health policies by providing decision-makers with baseline information on the pattern of use of ED resources, ensuring better resource deployment and greater access to care.

Optimizing Emergency Department Resource Allocation Using Discrete Event Simulation and Machine Learning Techniques

Background: Optimizing resource allocation in emergency departments (ED) is challenging due to limited resources and high costs. Objectives: The objective of this study was to utilize data mining algorithms and simulation modeling to predict the length of stay (LOS) of patients and compare scenarios for increasing bed productivity. Methods: Data mining algorithms, including Random Forest (RF) regression and CatBoost (CB) regression models, were used to predict the LOS based on patient demographic information and vital signs. The process of admission to discharge in the ED was simulated, and different scenarios were compared to identify strategies for increasing bed productivity. Results: The combination of RF regression and CB regression models performed better than other methods in predicting the LOS of patients. Simulation modeling demonstrated that optimal resource allocation and increased bed productivity could be achieved using predicted LOS values. Conclusions: This study demonstrates that a combined approach of data mining and simulation can effectively manage ED resources and reduce congestion. The findings highlight the potential of advanced analytical techniques for improving healthcare service delivery and patient outcomes.

Redirection of patients from the emergency department to ambulatory care: a feasibility study

§ 120 para. 3b SGB V mandates the Federal Joint Committee to define guidelines for the initial assessment of self-referred walk-in patients as well as for the redirection of patients who can be treated by office-based physicians. A corresponding streaming and redirection process was tested in a feasibility study at the RoMed Clinic Rosenheim. For the duration of the study, triage nurses of the emergency department (ED) first assessed self-referred walk-in patients with the Manchester Triage System (MTS). Patients in categories green and blue who did not obviously need the ED's resources were additionally assessed by health professionals of the Association of Statutory Health Insurance Physicians of Bavaria using the software Structured Initial Medical Assessment in Germany (SmED). Patients with a recommendation for non-hospital medical treatment were streamed to the out-of-hours practice on campus or were redirected to a physician office after video consultation with an office-based physician. Patient pathways were documented and a qualitative survey using semistructured guided interviews of all stakeholder groups was carried out. 1,091 self-referred walk-in patients were included. Direct streaming to the ED occurred in 525 cases,13 refused to participate. Based on SmED, 24 additional patients were referred to the ED, 514 patients were streamed to the out-of-hours practice, 23 received a video consultation and five left the ED. After video consultation, eight patients were redirected to a physician's office, 10 were discharged, and five referred to the ED of which one did not want an office-based physician. No returnees from practices to the ED were identified. Generally, the redirection process was evaluated positively in the interviews (n=18). In particular, potential for technical improvement was identified. Overall, the results indicate the feasibility of the redirection process and high acceptance levels. Using SmED in addition to MTS appeared useful before redirection but not necessary for streaming on campus. Redirection to physician offices can help reduce strain on the ED when the out-of-hours practice is not operating. In addition to arranging acute care appointments, video consultations offer an additional potential to treat patients. In a follow-up study, a broader range of patients should be included and appropriateness of redirection decisions should be evaluated.