Emergency department patients who stay more than 6 hours contribute to crowding

BACKGROUND

Admitted and discharged patients with prolonged emergency department (ED) stays may contribute to crowding by utilizing beds and staff time that would otherwise be used for new patients.

OBJECTIVES

To describe patients who stay > 6 h in the ED and determine their association with measures of crowding.

METHODS

This was a retrospective, observational study carried out over 1 year at a single, urban, academic ED.

RESULTS

Of the 96,562 patients seen, 16,017 (17%) stayed > 6 h (51% admitted). When there was at least one patient staying > 6 h, 60% of the time there was at least one additional patient in the waiting room who could not be placed in an ED bed because none was open. The walk-out rate was 0.34 patients/hour when there were no patients staying in the ED > 6 h, vs. 0.77 patients/hour walking out when there were patients staying > 6 h in the ED (p < 0.001). When the ED contained more than 3 patients staying > 6 h, a trend was noted between increasing numbers of patients staying in the ED > 6 h and the percentage of time the ED was on ambulance diversion (p = 0.011).

CONCLUSION

In our ED, having both admitted and discharged patients staying > 6 h is associated with crowding.

Emergency department patients who stay more than 6 hours contribute to crowding

BACKGROUND

Admitted and discharged patients with prolonged emergency department (ED) stays may contribute to crowding by utilizing beds and staff time that would otherwise be used for new patients.

OBJECTIVES

To describe patients who stay > 6 h in the ED and determine their association with measures of crowding.

METHODS

This was a retrospective, observational study carried out over 1 year at a single, urban, academic ED.

RESULTS

Of the 96,562 patients seen, 16,017 (17%) stayed > 6 h (51% admitted). When there was at least one patient staying > 6 h, 60% of the time there was at least one additional patient in the waiting room who could not be placed in an ED bed because none was open. The walk-out rate was 0.34 patients/hour when there were no patients staying in the ED > 6 h, vs. 0.77 patients/hour walking out when there were patients staying > 6 h in the ED (p < 0.001). When the ED contained more than 3 patients staying > 6 h, a trend was noted between increasing numbers of patients staying in the ED > 6 h and the percentage of time the ED was on ambulance diversion (p = 0.011).

CONCLUSION

In our ED, having both admitted and discharged patients staying > 6 h is associated with crowding.

A descriptive study of heavy emergency department users at an academic emergency department reveals heavy ED users have better access to care than average users

INTRODUCTION

Emergency department (ED) overcrowding has been a significant problem for the last 10 years. Several studies have shown that a relatively small number of ED patients are responsible for a disproportionate amount of ED visits. This study aims to describe the frequent users of our emergency department.

METHODS

This was an institutional review board-approved descriptive study performed by a retrospective review of electronic records. This pilot describes and compares patients who had 12 or more ED visits during the study year with those who visited less.

RESULTS

The 234 patients who met criteria for high-frequency use (HFU) of the emergency department were responsible for a total of 4633 visits. Sex, race, and age distribution of HFU patients were similar to those of general ED patients. Eighty-four percent of HF users have insurance and 93% have primary care providers. A relatively small percentage of HFU visits, 4%, were mental health-related visits and 3% were alcohol- and drug-related visits. The HFU visits are socially connected: 93% have their own homes; 94% have relatives or friends; 73% have a religious affiliation. Pain or pain-related conditions are the most common diagnoses. These patients are also frequent users of ambulatory care services.

CONCLUSION

The similarities between our HFU and the general ED population are more numerous than their differences. The HFU patients of our emergency department are different in terms of age, employment status, and type of insurance. IMPLICATIONS FOR NURSES: A detailed description of local HFU may help to inform planning and better meet ED patients' needs. As one of many results of this study, the ED chairman met with the Hematology-Oncology team and reviewed the protocol for ED management of sickle cell crisis. The meeting resulted in a revised protocol, including an immediate change in their pain medication from meperidine to either morphine or hydromorphone.

Management of multiple burn casualties in a high volume ED without a verified burn unit

The objective of the study was to evaluate the effectiveness of triage, treatment, and transfer interventions on multiple burn casualties managed in a high volume ED that does not have a verified in-hospital burn unit. The charts of 11 male patients injured in a 1999 foundry explosion and brought to Baystate Medical Center (BMC), a level I trauma center, were reviewed. All patients sustained deep partial and full thickness burns. The injury severity score (ISS) ranged from 9 to 75. Five patients had total body surface area (TBSA) burns of 10% to 50% and 6 patients had TBSA burns of 70% to 95%. Transfer times from the scene to BMC ranged from less than 5 minutes to 22 minutes. All 11 were initially triaged, resuscitated, and evaluated at BMC. Of the 9 patients transferred to verified burn units, 8 were intubated, 6 of 6 had negative abdominal ultrasounds, 4 had undergone escharatomies, and 1 had undergone bronchoscopy before transfer. Nine critically injured burn patients with ISS of 9 to 75 were transferred from BMC to verified burn units. For 8 of these patients, the average time from triage, evaluation, and treatment to transfer was 2 hours. The ninth patient was initially admitted overnight then promptly transferred after re-evaluation of his hand burns indicated a need for more specialized care. Two of 9 transferred patients, both with ISS of 75 died. Although 7 other patients had prolonged and complex courses, none of their subsequent complications were referable to missed injuries from this transferring facility. The resources and expertise of a high volume ED without an in-hospital burn unit can be effectively used in the initial resuscitation and treatment of multiple burn casualties. Coordinated responses among emergency medicine, trauma, anesthesia, and nursing personnel are instrumental to the rapid triage, resuscitation, and treatment of critically injured burn patients. Future disaster planning should incorporate a clearly demarcated, ED command center led by an easily identifiable "captain of the ship," as well as more accurate patient identification systems and improved communications with family members.

Preparing readable patient education handouts

Printed health educational materials, such as patient information handouts, booklets, pamphlets, and information sheets are among the most common and extensively used teaching tools (Rankin & Stallings, 1996). In this article, the author reports (1) the readability of patient information handouts developed by the nursing division and (2) the effect on the patient-teaching task force members of instruction on the readability of patient information handouts at a 79-bed community hospital in Southern Ontario.