title: Patient flow in the emergency department: the chest pain patient.
abstract: Prompt treatment of the chest pain patient in the emergency department (ED) is crucial. To ensure prompt treatment, identification of factors that delay flow of these patients through the department is essential. To identify factors that delay patient flow through the ED, the authors conducted a prospective study of all chest pain patients, using a time-flow analysis. Eighty-eight (36%) of 245 patients required critical unit admissions and had an average department stay of 3 1/2 hours. Flow differences were seen between critical and noncritical care patients. Three primary sources of delay were identified: critical unit bed availability, the registration process, and the role of the unit admitting resident. Additional findings confirmed the efficacy and role of the triage nurse in patient flow. Nursing and medical education and staffing needs were addressed. The use of the community's emergency medical services was examined by analyzing the disposition of patients arriving at the ED by ambulance.
authors.affiliation: Department of Emergency Medicine, Fairfax Hospital, Falls Church, VA 22046.
authors.forename: P A
authors.initials: PA
authors.lastname: Lupfer
authors.forename: M
authors.initials: M
authors.lastname: Altieri
authors.forename: M J
authors.initials: MJ
authors.lastname: Sheridan
authors.forename: C C
authors.initials: CC
authors.lastname: Lilly
mesh_terms: D001509:Bed Occupancy; D002637:Chest Pain / Q000628:therapy*; D004636:Emergency Service, Hospital / Q000592:standards*; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D007362:Intensive Care Units; D007396:Internship and Residency / Q000592:standards; D007902:Length of Stay; D008297:Male; D008485:Medical Audit; D009741:Nursing Staff, Hospital / Q000592:standards; D010343:Patient Admission / Q000706:statistics & numerical data; D010360:Patient Transfer / Q000379:methods / Q000458:organization & administration / Q000592:standards*; D010819:Physician's Role; D011446:Prospective Studies; D013996:Time and Motion Studies; D014218:Triage / Q000458:organization & administration / Q000592:standards*; D014768:Virginia; D000078329:Workforce