title: A novel approach to improving emergency department consultant response times.
abstract: BACKGROUND
  Emergency department (ED) overcrowding is a threat to patient safety and public health. Availability of specialty consultation to the ED may contribute to overcrowding. We implemented a novel intervention using education, goal setting and real-time performance feedback to improve time to admission for patients referred to general internal medicine (GIM).
  
  
  METHODS
  Using a time-series design, we examined the effects of a quality improvement intervention on ED wait-times in an academic medical centre. The multifaceted approach included a didactic session for GIM housestaff on medicine triage principles and methods; setting a goal to have disposition decisions and, where appropriate, admission order within 4 h of consultation request; and providing personal data feedback on their performance on this metric to GIM housestaff during their rotation on the inpatient teaching service over a 1-year period. We compared time from consultation request to disposition decision and overall ED length of stay (LOS) for all patients referred to GIM during the intervention period (February 2011-February 2012) with data from the control period (January 2010-January 2011).
  
  
  RESULTS
  Mean time from GIM consultation request to admission order entry decreased by 92 min (SD, 5, p<0.05) from 321min in the control period to 229 min in the intervention period. Overall ED LOS for GIM patients decreased by 59 min (SD, 14, p<0.05) for admitted patients from 1022 min in the control period to 963 min in the intervention period, and by 40 min (SD, 13, p<0.05) for all patients referred to GIM. GIM staffing and patient characteristics remained stable across the two periods.
  
  
  CONCLUSIONS
  ED throughput for admitted medical patients improved with a quality improvement initiative involving education, goal setting and performance feedback.
authors: Division of General Internal Medicine, University of Toronto, Toronto, Ontario, Canada. CSoong@mtsinai.on.ca
authors: Christine
authors: C
authors: Soong
authors: Sasha
authors: S
authors: High
authors: Matthew W
authors: MW
authors: Morgan
authors: Howard
authors: H
authors: Ovens
mesh_terms: D003657:Decision Making; D017598:Efficiency, Organizational; D004636:Emergency Service, Hospital / Q000592:standards*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D010343:Patient Admission / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000706:statistics & numerical data; D061214:Patient Safety; D010360:Patient Transfer / Q000592:standards*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D013997:Time Factors