Background: Fueled by a decade-long increase in emergency department (ED) visits with a concomitant decrease in hospital bed capacity and the number of hospital EDs, ED crowding has reached crisis proportions. Robust information systems and process redesign are two strategies to improve the safety and quality of emergency care. At the ED at the Mount Sinai Medical Center, an urban, tertiary care academic medical center in New York City, elements of departmental work flow were redesigned to streamline patient throughput before implementation of a fully integrated emergency department information system (EDIS) with patient tracking, computerized charting and order entry, and direct access to patient historical data from the hospital data repository. Pre- and postintervention data were analyzed to examine the impact on (ED) efficiency. Results: The length of stay for all patients (arrival to time patient left ED) decreased by 1.94 hours, from 6.69 (n = 508) pre-intervention to 4.75 (n = 691) postintervention (p < .001); doctor-to-disposition time (first doctor-patient contact to disposition decision) decreased by 1.90 hours, from 3.64 (n = 508) to 1.74 (n = 691; p < .001); door-to-doctor time (triage to first doctor-patient contact) decreased by 0.54 hours, from 1.22 (n = 508) to 0.68 (n = 691; p < .001). X-ray turnaround time (TAT) decreased by 0.18 hours from 0.92 (n = 60) to 0.74 (n = 108; p = .179); computerized tomography (CT) scan TAT decreased by 1.56 hours, from 3.89 (n = 40) to 2.33 (n = 29; p < .001), lab TAT decreased by 0.59 hours, from 2.03 (n = 121) to 1.44 (n = 271; p = .006). Conclusions: Increasing the clinical information available at the bedside and improving departmental work flow through EDIS implementation and process redesign led to decreased patient throughput times and improved ED efficiency.
Document Type: Research Article
Publication date: April 1, 2010
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Published monthly, The Joint Commission Journal on Quality and Patient Safety is a peer-reviewed publication dedicated to providing health professionals with the information they need to promote the quality and safety of health care. The Joint Commission Journal on Quality and Patient Safety invites original manuscripts on the development, adaptation, and/or implementation of innovative thinking, strategies, and practices in improving quality and safety in health care. Case studies, program or project reports, reports of new methodologies or new applications of methodologies, research studies on the effectiveness of improvement interventions, and commentaries on issues and practices are all considered.
Also known as Joint Commission Journal on Quality Improvement and Joint Commission Journal on Quality and Safety