A rapid admission protocol to reduce emergency department boarding times.
BACKGROUND
Prolonged emergency department boarding times (EDBT) are associated with adverse clinical outcomes and longer hospital stays. A rapid admission protocol was designed at our institution to reduce both EDBT and time to admission orders (EDTAO) for patients admitted to the internal medicine service.


METHODS
The existing admission process was examined by a team of clinical and administrative leaders who focused on developing a change management architecture, narrowing clinical roles, mandating direct communication, establishing clear boundaries for patient responsibility and instituting carefully constructed holding orders. The number of steps in the admission process was reduced from 50 to 10. We collected EDBT and EDTAO for all patients admitted to the internal medicine service before and after intervention using a simple interrupted time-series design.


RESULTS
The study involved a total of 9604 admissions to one of three inpatient destinations (general medicine ward, telemetry or intensive care unit). The overall EDBT decreased from 360 min in the preintervention period to 270 min in phase 4 (p<0.001). The overall time to admission orders decreased from 210 min in the preintervention period to 75 min in phase 4 (p<0.001) overall. However, no improvements were noted in EDBT for telemetry or ICU patients.


CONCLUSIONS
Institution of a rapid admission protocol successfully reduced overall EDBT at our institution, although few gains were noted for patients with a telemetry or ICU destination. In total, the intervention saved 27 884 h, or 1161 emergency department patient-days, over the course of a single year.
Amarasingham
Ruben
R
Center for Clinical Innovation at Parkland Health & Hospital System - UT Southwestern Medical Center, Dallas, Texas 75235, USA. ramara@parknet.pmh.org
Swanson
T S
TS
Treichler
D B
DB
Amarasingham
S N
SN
Reed
W G
WG
D001071:Appointments and Schedules; D002985:Clinical Protocols; D017598:Efficiency, Organizational; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D006779:Hospitals, Public; D006801:Humans; D007388:Internal Medicine; D009936:Organizational Innovation; D010343:Patient Admission / Q000592:standards*; D010348:Patient Care Team; D017064:Process Assessment, Health Care / Q000379:methods; D013781:Texas; D013997:Time Factors