title: Improved physician consult response times in an academic Emergency Department after implementation of an institutional guideline.
abstract: BACKGROUND
  Physician consultation in the Emergency Department (ED) can account for a significant portion of ED length of stay, which can lead to poor clinical outcomes.
  
  
  OBJECTIVE
  The purpose of this study was to determine whether an institutional guideline could lead to a reduction in time between consult request and admission decision. This guideline codified a 90-min expected time interval to arrive and complete an admission disposition where the consulting and admitting service were the same in an academic ED with weekly audits and reports to departmental chairs and hospital administrators.
  
  
  METHODS
  This was a study of consultation times of patients who presented to an academic ED 6 months before the adoption of an institutional guideline and 6 months after the adoption of the guideline. Data measurement in both periods included the length of time from ED consult order to admission disposition, time of ED discharge, number of ED consultations (single and multiple), ED admissions, and the hospital discharge time of admitted patients.
  
  
  RESULTS
  Physician consult response time decreased from 121 min to 100 min (p < 0.0001), and patients left the ED 18 min earlier (p = 0.0221) after implementation of the consultation guideline despite more ED visits, consultations, and admissions in the post-implementation time period. Patients were discharged from the inpatient setting 50 min later (p < 0.0001) after implementation of the guideline.
  
  
  CONCLUSIONS
  An institutional guideline codifying timely ED consultations led to a significant reduction in the time from ED consultation to admission disposition while also allowing patients to leave the ED earlier in a high-occupancy academic medical center. However, the discharge time of admitted hospital patients was later after implementation of the guideline.
authors: Department of Internal Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA.
authors: Joseph M
authors: JM
authors: Geskey
authors: Glenn
authors: G
authors: Geeting
authors: Cheri
authors: C
authors: West
authors: Christopher S
authors: CS
authors: Hollenbeak
mesh_terms: D000046:Academic Medical Centers; D003657:Decision Making; D017598:Efficiency, Organizational; D004636:Emergency Service, Hospital; D017408:Guidelines as Topic; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D010343:Patient Admission / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D013997:Time Factors