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A rapid admission protocol to reduce emergency department boarding times
  1. R Amarasingham1,2,
  2. T S Swanson1,
  3. D B Treichler3,
  4. S N Amarasingham4,
  5. W G Reed1,2
  1. 1Center for Clinical Innovation at Parkland Health & Hospital System, Dallas, Texas, USA
  2. 2Department of Internal Medicine, Division of General Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
  3. 3Department of Surgery, Division of Emergency Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
  4. 4Children's Medical Center, Dallas, Texas, USA
  1. Correspondence to Dr Ruben Amarasingham, Center for Clinical Innovation at Parkland Health & Hospital System - UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75235, USA; ramara{at}parknet.pmh.org

Abstract

Introduction Prolonged emergency department boarding times (EDBT) are associated with adverse clinical outcomes and longer hospital stays. A rapid admission protocol was designed at our institution to reduce both EDBT and time to admission orders (EDTAO) for patients admitted to the internal medicine service.

Methods The existing admission process was examined by a team of clinical and administrative leaders who focused on developing a change management architecture, narrowing clinical roles, mandating direct communication, establishing clear boundaries for patient responsibility and instituting carefully constructed holding orders. The number of steps in the admission process was reduced from 50 to 10. We collected EDBT and EDTAO for all patients admitted to the internal medicine service before and after intervention using a simple interrupted time-series design.

Results The study involved a total of 9604 admissions to one of three inpatient destinations (general medicine ward, telemetry or intensive care unit). The overall EDBT decreased from 360 min in the preintervention period to 270 min in phase 4 (p<0.001). The overall time to admission orders decreased from 210 min in the preintervention period to 75 min in phase 4 (p<0.001) overall. However, no improvements were noted in EDBT for telemetry or ICU patients.

Conclusions Institution of a rapid admission protocol successfully reduced overall EDBT at our institution, although few gains were noted for patients with a telemetry or ICU destination. In total, the intervention saved 27 884 h, or 1161 emergency department patient-days, over the course of a single year.

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Footnotes

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the University of Texas Southwestern Medical Center and Parkland Health & Hospital System Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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