Characterizing ER Activities for Failure Prevention

Overcrowding in the emergency department (ED) is a pressing healthcare issue globally and has been shown to negatively affect the quality of treatment, clinical outcomes and patient satisfaction.

In recent years, an increasing number of studies have tried to implement changes in the ED to increase efficiency and thereby reduce the length of stay (LOS). Examples to these efforts include physician triage, expanding the nursing scope of practice and patient-flow design (e.g., creating fast track units) in the ED. Importantly, not all intuitive changes in the ED resulted in the reduction of LOS Therefore, implementing changes in the ED must be done with caution and preceded with a cost-benefit analysis of the effects of the intervention using available retrospective data.

This research was conducted in the ED of Sheba Medical Center (SMC), a tertiary government-owned hospital in Israel with 1400 beds. This study is a retrospective medical record review of patients admitted to the adult primary SMC ED. The study sample comprises all the walk-in patients that visited the ED between January 2013 and December 2017. The data here does not include other EDs located elsewhere in SMC, (e.g., pediatric ED, gynecology ED, ophthalmology ED, and psychiatric ED). All admissions files in SMC ED are recorded in a computerized system with negligible exceptions (such as power outage and connection or server maintenance). The time and date of every change in the electronic files are also recorded in the system. Therefore, it is possible to track the waiting times as well as the full content of the admission file.

The aim of this study is to identify and analyze potential modifications in current ED practice which may improve outcomes such as LOS, missed diagnosis, leaving without being seen, patient satisfaction, etc.