John A Burke1, Jaimi Greenslade1,2, Jadwiga Chabrowska1, Katherine Greenslade1, Sally Jones1, Jacqueline Montana1, Anthony Bell1, Alan O'Connor3,4,5. 1. Department of Emergency Medicine, Royal Brisbane Hospital, Brisbane, Queensland, Australia. 2. School of Medicine, The University of Queensland, Brisbane, Queensland, Australia. 3. Discipline of Acute Care Medicine, The University of Adelaide, Adelaide, South Australia, Australia. 4. Department of Emergency Medicine, Riverland General Hospital, Adelaide, South Australia, Australia. 5. Department of Emergency Medicine, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia.
Abstract
OBJECTIVE: The objective of this study was to assess the implementation of a novel ED model of care, which combines clinical streaming, team-based assessment and early senior consultation to reduce length of stay. METHODS: A pre-post-intervention study was used to compare ED performance following an extensive clinical redesign programme. Clinical teams and work sequences were reconfigured to promote the role of the staff specialist, with a focus on earlier decisions regarding disposition. Primary outcome measures were ED length of stay and National Emergency Access Target (NEAT) compliance. Secondary outcomes included referral and workup times, wait times by triage category, ambulance offload times, ward discharges and unit transfers within 24 h of admission, representation within 48 h, and Medical Emergency Response Team (MERT) calls within 24 h of admission. RESULTS: Two seasonally matched 26 week intervals were compared with adjustment for demographics, triage category and arrival by ambulance. Overall, there was an 18.4% rise in NEAT performance (95% confidence interval (CI): 17.7-19.1) while ED length of stay decreased by a total of 86.8 min (95% CI: 83.6-90.1). Time series analysis did not suggest any preexisting trends to explain these results. The average time to referral decreased by 74.7 min (95% CI: 69.8-79.6) and waiting times decreased across all triage categories. Rates of MERT activation and unplanned representation were unchanged. CONCLUSION: A facilitated team leader role for senior doctors can help to reduce length of stay by via early disposition, without significant risks to the patient.
OBJECTIVE: The objective of this study was to assess the implementation of a novel ED model of care, which combines clinical streaming, team-based assessment and early senior consultation to reduce length of stay. METHODS: A pre-post-intervention study was used to compare ED performance following an extensive clinical redesign programme. Clinical teams and work sequences were reconfigured to promote the role of the staff specialist, with a focus on earlier decisions regarding disposition. Primary outcome measures were ED length of stay and National Emergency Access Target (NEAT) compliance. Secondary outcomes included referral and workup times, wait times by triage category, ambulance offload times, ward discharges and unit transfers within 24 h of admission, representation within 48 h, and Medical Emergency Response Team (MERT) calls within 24 h of admission. RESULTS: Two seasonally matched 26 week intervals were compared with adjustment for demographics, triage category and arrival by ambulance. Overall, there was an 18.4% rise in NEAT performance (95% confidence interval (CI): 17.7-19.1) while ED length of stay decreased by a total of 86.8 min (95% CI: 83.6-90.1). Time series analysis did not suggest any preexisting trends to explain these results. The average time to referral decreased by 74.7 min (95% CI: 69.8-79.6) and waiting times decreased across all triage categories. Rates of MERT activation and unplanned representation were unchanged. CONCLUSION: A facilitated team leader role for senior doctors can help to reduce length of stay by via early disposition, without significant risks to the patient.
Authors: Bo Schouten; Babiche E J M Driesen; Hanneke Merten; Brigitte H C M Burger; Mariëlle G Hartjes; Prabath W B Nanayakkara; Cordula Wagner Journal: Eur Geriatr Med Date: 2021-11-10 Impact factor: 3.269
Authors: Peter Del Mar; Min Joung Kim; Nathan J Brown; Joon Min Park; Kevin Chu; John Burke Journal: Emerg Med Australas Date: 2022-08-23 Impact factor: 2.279