Prospective evaluation of daily performance metrics to reduce emergency department length of stay for surgical consults.
BACKGROUND
As part of a quality improvement initiative to reduce Emergency Department (ED) length of stay (LOS) for surgical consult patients, we e-mailed performance metrics to key stakeholders on a daily basis. ED and Surgery leadership used these daily metrics to identify and remedy contributing factors for increased ED LOS in patients who received surgical consults.


OBJECTIVE
To evaluate whether a quality improvement process driven by a daily performance metric e-mail would be associated with a change in ED LOS for surgical consult patients.


METHODS
Prospective before-after study looking at ED LOS for surgical consult patients after an e-mail intervention at a tertiary academic teaching hospital. All consecutive adult ED patients between July 1, 2010 and October 1, 2010 who received a general surgical consult were enrolled. The primary outcome measure was ED LOS, and secondary outcome measure was time to consultation.


RESULTS
There were 916 patients who had surgical consults placed during the study period; 459 patients presented before the intervention and 457 patients presented after the intervention. The median LOS decreased 54 min, from 463 min (interquartile range [IQR] 326-617) before the intervention to 409 min (IQR 294.5-528.5) after the intervention (p < 0.001). Time to consultation decreased 25 min, from a median of 160 min (IQR 87-265) to 135 min (IQR 70-239.5) (p = 0.002). There was no difference in age, severity, number of consults, or disposition. There was also no difference in median LOS for other consultation services or in previous years during the same time period.


CONCLUSIONS
ED LOS and time to consultation were decreased for surgical consult patients after initiation of daily performance metric e-mails.
Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Steven
S
Horng
Lina
L
Pezzella
Carrie D
CD
Tibbles
Richard E
RE
Wolfe
James M
JM
Hurst
Larry A
LA
Nathanson
D000046:Academic Medical Centers; D017598:Efficiency, Organizational; D004636:Emergency Service, Hospital; D005260:Female; D013502:General Surgery; D006784:Hospitals, Teaching; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011446:Prospective Studies; D058996:Quality Improvement; D012017:Referral and Consultation; D014193:Trauma Centers