title: Processes and impediments in moving patients from the emergency department: pilot study.
abstract: OBJECTIVE
  To assess the impact of an ED-designed interim orders sheet on patient flow through the ED, and the safety of ED-directed admission.
  
  
  METHODS
  The flow of patients through the ED and inpatient length of stay (IPLOS) was retrospectively reviewed on 135 patients who were admitted using interim orders and 125 patients who were admitted after inpatient unit review in the ED.
  
  
  RESULTS
  The median time to admission to the ward in the non-interim orders group was 5.7 h (interquartile range [IQR]: 3.8-8.5), with a range from 1.2 to 15.9 h, and in the interim orders group was 6.3 h (IQR: 4.8-8.0) with a range from 0.5 to 22 h (P=0.27). The median IPLOS was 4 days (IQR: 2.0-7.0) in the interim orders group, and 4 days (IQR: 2.1-9.0) in the non-interim orders group (P=0.19).
  
  
  CONCLUSIONS
  There was no difference in the time to patient admission, or IPLOS, with the different processes. Almost half of the average ED stay of adults and about one-third of that of paediatric admissions occurred after the decision to admit was made. Transfer of patients to the ward without inpatient review is appropriate and effective.
authors.affiliation: Department of Emergency Medicine, Royal Children's Hospital, Parkville, Victoria, and Department of Medicine, University of Melbourne, Australia. ed.oakley@rch.org.au
authors.forename: Edward
authors.initials: E
authors.lastname: Oakley
authors.forename: George
authors.initials: G
authors.lastname: Braitberg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D017598:Efficiency, Organizational; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D010360:Patient Transfer / Q000458:organization & administration*; D010865:Pilot Projects; D012189:Retrospective Studies; D017748:Time Management; D014218:Triage / Q000458:organization & administration; D014739:Victoria