Hospitalist-led ED reduces diversion, improves patient flow

By Sarah Guy, medwireNews Reporter

Implementing a hospital medicine-led emergency department (HMED) team could reduce the number of times such departments are forced to divert new patients because of a lack of beds, as well as improve patient flow, show study findings.

Specifically, rates of unnecessary transfers to medicine units decreased and rates of discharge from the ED increased after the HMED system was implemented.

ED staff at the Denver Health Medical Center in Colorado, USA, which introduced the program also reported very high levels of satisfaction with it, and the decreased diversion rates accounted for over US$ 500,000 (€ 398,800) increased annual revenue, say the researchers.

Indeed, 94% of ED staff agreed that quality of care and communication had improved, and that collegiality and clinical decision-making improved as a result of the HMED.

"The HMED team allowed nursing supervisors to have direct knowledge regarding clinical status, including telemetry and ICU [intensive care unit] criteria... and readiness for discharge from the physician taking care of the patient," explain Smitha Chadaga (Denver Medical Health Center) and colleagues.

The HMED team's physician also maintained a constant hospital census via an electronic bed board, and communicated regularly with other floors, they add in the Journal of Hospital Medicine.

The HMED was implemented at a 477-bed unit for 24 hours per day, and provided ongoing care to patients still awaiting a medicine ward bed at 07:00 h, and initiated and continued care of new admissions until discharge or transfer.

A total of 48,595 patients passed through the ED during the 2009 to 2010 implementation period, compared with 50,469 during the 2008 to 2009 control period, report the authors.

ED diversion due to lack of bed capacity fell by a significant 27% with the HMED team compared with control, report Chadaga and team. This extrapolates to 105.1 hours per year of decreased diversion time, or $ 525,600 (€ 419, 260) of increased annual revenues.

They also found that the HMED team carried out rounds a mean 2 hours and 9 minutes earlier than staff did during the control period, and the rate of patients transferred to another medicine floor but then discharged within 8 hours decreased by a significant 67% after implementation of the HMED.

Discharges from the ED increased by a significant 61% with the HMED, they add.

"An HMED team can improve patient flow and decrease ED diversion while providing more timely care to patients boarded in the ED," conclude Chadaga et al.

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