title: The effect of gynecologic algorithm pathways on emergency department visit times.
abstract: BACKGROUND
  The use of multidisciplinary algorithmic pathways is one strategy to improve efficiency and quality of care in Emergency Departments (EDs). To this end, in the fall of 2005, we implemented algorithmic pathways for evaluation of ED patients with common gynecologic complaints.
  
  
  OBJECTIVE
  The goals of this initiative were to improve length of stay as a marker for operational efficiency and to reduce health care disparities by ensuring consistent management regimens for all patients.
  
  
  METHODS
  A retrospective observational comparison study was performed through a review of consults in the year preceding and the year after implementation of the pathways. The length of stay was calculated based on time of initial triage until discharge. The length of stay from both groups was compared using an unpaired Student's t-test analysis.
  
  
  RESULTS
  There was an 85-min decrease in the mean visit time between the pre-intervention group (108 patients, 610 min, SD 345.4) and the post-intervention group (105 patients, 525 min, SD 251.5), p=0.04.
  
  
  CONCLUSIONS
  Algorithmic pathways had a positive impact on patient care as measured by the average amount of time our patients spent in the ED. Gynecologic care in the ED was standardized, and length of stay for patients with gynecologic complaints decreased. The implementation of algorithms resulted in more consistent care with earlier initiation of pertinent studies, while facilitating more rapid critical decision-making by providers from both departments. Further analysis is required to examine cost-effectiveness as well as patient safety and provider satisfaction issues.
authors.affiliation: Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, Maryland 21287, USA.
authors.forename: Amy S D
authors.initials: AS
authors.lastname: Lee
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Cohen
authors.forename: Jean R
authors.initials: JR
authors.lastname: Anderson
authors.forename: Arjun
authors.initials: A
authors.lastname: Chanmugam
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Bienstock
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D019091:Critical Pathways / Q000458:organization & administration*; D017598:Efficiency, Organizational / Q000592:standards; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000592:standards; D005260:Female; D006176:Gynecology / Q000458:organization & administration*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care / Q000592:standards; D014218:Triage / Q000458:organization & administration; D055815:Young Adult