title: Changes in patient flow among five hospitals participating in a learning collaborative.
abstract: This was an evaluation of the efforts of five hospitals that participated in a collaborative aimed at improving patient flow and reducing emergency department (ED) crowding. Interviews with hospital implementation team members were conducted at two separate times, and multivariate linear regression models and bivariate logistic models were constructed to assess changes in ED length of stay (LOS) and left without being seen (LWBS). By the end of the collaborative, four of the five hospitals had at least one fully implemented improvement strategy. Those hospitals experienced modest improvements in patient flow: a hospital that implemented front-end improvements and devoted additional resources to fast track had a 51-min reduction in ED LOS, another that implemented only front-end improvements had a 9-min reduction in LOS, a third hospital that improved communication between the ED and inpatient units to facilitate admissions decreased LWBS from 0.6% to 0.4%, and a fourth hospital reduced LOS by 59 min for mid-acuity patients by establishing a new care process for them. Results suggest that relatively small changes may lead to improvements in measures of patient flow that are modest, at best.
authors.affiliation: Department of Emergency Medicine, Northwestern University, Feinberg School of Medicine, USA. megan-mchugh@northwestern.edu
authors.forename: Megan
authors.initials: M
authors.lastname: McHugh
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Van Dyke
authors.forename: Embry
authors.initials: E
authors.lastname: Howell
authors.forename: Fiona
authors.initials: F
authors.lastname: Adams
authors.forename: Dina
authors.initials: D
authors.lastname: Moss
authors.forename: Julie
authors.initials: J
authors.lastname: Yonek
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003299:Cooperative Behavior; D003441:Crowding; D017598:Efficiency, Organizational; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000706:statistics & numerical data / Q000639:trends; D005260:Female; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000706:statistics & numerical data / Q000639:trends*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009936:Organizational Innovation; D010343:Patient Admission / Q000592:standards* / Q000706:statistics & numerical data / Q000639:trends; D058996:Quality Improvement / Q000458:organization & administration / Q000592:standards / Q000706:statistics & numerical data; D055815:Young Adult