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Impact of emergency department discharge stream short stay unit performance and hospital bed occupancy rates on access and patient flowmeasures: A single site study.
Shetty, Amith L; Teh, Caleb; Vukasovic, Matthew; Joyce, Shannon; Vaghasiya, Milan R; Forero, Roberto.
Afiliación
  • Shetty AL; Emergency Department, Westmead Hospital, Sydney, New South Wales, Australia.
  • Teh C; Sydney Medical School - Westmead Campus, The University of Sydney, Sydney, New South Wales, Australia.
  • Vukasovic M; The Sydney Children's Hospitals Network, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
  • Joyce S; Emergency Department, Westmead Hospital, Sydney, New South Wales, Australia.
  • Vaghasiya MR; Emergency Department, Westmead Hospital, Sydney, New South Wales, Australia.
  • Forero R; Emergency Department, Westmead Hospital, Sydney, New South Wales, Australia.
Emerg Med Australas ; 29(4): 407-414, 2017 Aug.
Article en En | MEDLINE | ID: mdl-28419793
OBJECTIVE: The ED discharge stream short stay units (EDSSUs) aim to facilitate patient flows through EDs. We investigate the relationship between EDSSU census and hospital bed occupancy rates (BORs) on National Emergency Access Target (NEAT) performance and did-not-wait (DNW) rates at a tertiary metropolitan adult ED in Sydney, Australia. METHODS: We collated data for all ED presentations between 1 January 2012 and 31 December 2014. Daily ED, EDSSU census and ED-accessible hospital BORs were tabulated with daily ED NEAT performance and DNW rates. Non-parametric regression analyses was conducted on cohorts of appropriate, inappropriate, successful and failed EDSSU admissions based on local admission policies and BOR for NEAT and DNW outcomes. RESULTS: Among all presentations (n = 192 506) during the study period, 43.8% of patients were admitted in hospital including 10.4% for EDSSU (n = 20 081). Analyses reveal modest positive correlation of EDSSU admissions with NEAT performance (τ = 0.35, P < 0.001) and weak negative correlation with DNW rates (τ = -0.29, P < 0.001). These associations were more pronounced on days when BOR >100% (τ = 0.39 and τ = -0.36, P < 0.001). BOR of >100% were associated with reduced EDSSU admits, NEAT performance and increased DNW rates (P < 0.001). Appropriate EDSSU admissions had shorter EDSSU length of stay than inappropriate EDSSU admissions (350 vs 557 min, median difference -158 min, P < 0.001). CONCLUSION: Appropriate use of EDSSU provides effective conduit for ongoing patients' management beyond mandated timelines. Health systems should focus on reducing hospital BORs to mitigate exclusive ED pressure to deliver NEAT performance targets.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Admisión del Paciente / Accesibilidad a los Servicios de Salud / Hospitalización Tipo de estudio: Diagnostic_studies / Etiology_studies / Incidence_studies / Observational_studies / Risk_factors_studies Aspecto: Determinantes_sociais_saude Límite: Adult / Aged / Female / Humans / Male / Middle aged País/Región como asunto: Oceania Idioma: En Revista: Emerg Med Australas Asunto de la revista: MEDICINA DE EMERGENCIA Año: 2017 Tipo del documento: Article País de afiliación: Australia Pais de publicación: Australia
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Admisión del Paciente / Accesibilidad a los Servicios de Salud / Hospitalización Tipo de estudio: Diagnostic_studies / Etiology_studies / Incidence_studies / Observational_studies / Risk_factors_studies Aspecto: Determinantes_sociais_saude Límite: Adult / Aged / Female / Humans / Male / Middle aged País/Región como asunto: Oceania Idioma: En Revista: Emerg Med Australas Asunto de la revista: MEDICINA DE EMERGENCIA Año: 2017 Tipo del documento: Article País de afiliación: Australia Pais de publicación: Australia