RESUMEN
BACKGROUND: Emergency departments (EDs) have been struggling with overcrowding issues for years. Some spatial configurations have been proposed to improve ED performance in facing overcrowding. Despite similarities with mass casualty incidents (MCIs), when demand for care exceeds the capacity, little is documented about the application of the proposed configurations during MCIs to improve surge capacity. OBJECTIVES: We aimed to explore the potential of spatial configurations that have been proposed to handle ED overcrowding in daily operations so as to improve surge capacity during MCIs. METHODS: Using an online Likert-scale survey, 11 spatial design strategies were rated by ED care teams in terms of their potential to improve surge capacity during MCIs. RESULTS: Responses from 72 participants revealed that establishing an in-house lab was perceived as the most potential strategy, followed by rapid care area, internal waiting rooms, and in-house imaging. In contrast, separate entrance and exit doors, as well as decentralized nurse stations, were perceived as the least potential strategies but also exhibited the most variance in response. Respondents' comments implied that their choice of in-house ancillary services was primarily to improve communication and to reduce turnaround time and risk of errors. Their choice of rapid care and internal waiting areas related to improved flexibility. CONCLUSIONS: Understanding clinicians' perspectives on potentially effective spatial configurations aids in implementing balanced strategies to better equip EDs to handle overcrowding in daily operations and manage surges during MCIs.
Asunto(s)
Incidentes con Víctimas en Masa , Capacidad de Reacción , Servicio de Urgencia en Hospital , HumanosRESUMEN
PROBLEM: Struggling to keep up with The Centers for Medicare and Medicaid Services out-patient throughput metrics, an adult emergency department serving Burlington and Camden Counties, New Jersey, sought to redefine its care delivery model by adopting the patient segmentation initiatives of the split-flow process of patient care. METHODS: A multidisciplinary team of ED clinicians collaboratively defined the patient segmentation criteria. A joint assessment team approach to patient care was instituted. A 3-pronged approach was adopted to prepare staff for the patient care changes in line with an existing framework specified by the Institute of Medicine. Simulation and queuing analyses were used to estimate the accompanying resource needs. RESULTS: Since implementing split flow, the emergency department has witnessed significant improvements in patient throughput and patient satisfaction, despite a sustained 10% increase in patient volumes after split-flow implementation. The median length of stay for discharged patients and the door-to-diagnostic evaluation time are now down to 112 minutes and 30 minutes, respectively, compared with pre-split-flow values of 192 minutes and 72 minutes, respectively. IMPLICATIONS FOR PRACTICE: Working collaboratively with all stakeholders to define the right patient care delivery model, combined with an understanding of the right resource assignments to optimally support that care delivery model, an emergency department can institute cost-effective changes to realize and sustain significant patient throughput improvements.