Subcutaneous Recombinant Human Hyaluronidase: Workflow Analysis and Emergency Department Design

SPECIFIC AIMS This study examines the operational consequences and training requirements for implementing subcutaneous hydration vs. standard intravenous hydration in emergency departments.

B. BACKGROUND AND SIGNIFICANCE Emergency departments across the nation are overcrowded. Emergency department visits hit a new high in 2005, with more than 115 million visits, an increase of 5 million visits over the previous year, and a 20 percent increase over 10 years. During the same period the number of hospital EDs decreased more than 9 percent from 4,176 to 3,795. A consequence of the increase in demand occurring during a decrease in capacity, according to the American College of Emergency Physicians is that 60 percent of EDs report that the overcrowding has forced their facilities to divert patients and though more than 70 percent of hospitals reported having a goal of admitting patients within two hours of arrival in the emergency department, almost half of that group routinely fails.

Overcrowding not only results in delayed treatment, long patient waiting time, overburdened working staff, patient elopement, and low throughput, it also results in increased medical errors due to overloading and significant legal and financial risks.

These issues have led to a number of initiatives with, potentially the most profound being the 2007 Joint Commission requirement ( Leadership Standard, LD.3.15) requiring hospital leadership to:"... develop and implement plans to identify and mitigate impediments to efficient patient flow throughout the hospital".

Developing processes and procedures that can improve patient flow in EDs, improve efficiency and reduce crowding is in all parties interests.