title: Reducing patient placement errors in emergency department admissions: right patient, right bed.
abstract: BACKGROUND
  Because lack of inpatient capacity is associated with emergency department (ED) crowding, more efficient bed management could potentially alleviate this problem. Our goal was to assess the impact of involving a patient placement manager (PPM) early in the decision to hospitalize ED patients. The PPMs are clinically experienced registered nurses trained in the institution-specific criteria for correct unit and bed placement.
  
  
  METHODS
  We conducted two pilot studies that included all patients who were admitted to the adult hospital medicine service: 1) 10/24 to 11/22/2010 (30 days); and 2) 5/24 to 7/4/2011 (42 days). Each pilot study consisted of a baseline control period and a subsequent study period of equal duration. In each pilot we measured: 1) the number of "lateral transfers" or assignment errors in patient placement, 2) median length of stay (LOS) for "all" and "admitted" patients and 3) inpatient occupancy. In pilot 2, we added as a measure code 44s, i.e. status change from inpatient to observation after patients are admitted, and also equipped all emergency physicians with portable phones in order to improve the efficiency of the process.
  
  
  RESULTS
  In pilot 1, the number of "lateral transfers" (incorrect patient placement assignments) during the control period was 79 of the 854 admissions (9.3%) versus 27 of 807 admissions (3.3%) during the study period (P<0.001). We found no statistically significant differences in inpatient occupancy or ED LOS for "all" or for "admitted" patients. In pilot 2, the number of "lateral transfers" was 120 of 1,253 (9.6%) admissions in the control period and 42 of 1,229 (3.4%) admissions in the study period (P<0.001). We found a 49-minute (352 vs. 401 minutes) decrease in median LOS for "admitted" ED patients during the study period compared with the control period (P=0.04). The code 44 rates, median LOS for "all" patients and inpatient occupancy did not change.
  
  
  CONCLUSIONS
  Inclusion of the PPM in a three-way handoff conversation between emergency physicians and hospitalist providers significantly decreased the number of "lateral transfers." Moreover, adding status determination and portable phones for emergency physicians improved the efficiency of the process and was associated with a 49 (12%) minute decrease in LOS for admitted patients.
authors.affiliation: Baystate Medical Center, Springfield, Massachusetts.
authors.forename: Niels K
authors.initials: NK
authors.lastname: Rathlev
authors.affiliation: Baystate Medical Center, Springfield, Massachusetts.
authors.forename: Christine
authors.initials: C
authors.lastname: Bryson
authors.affiliation: Baystate Medical Center, Springfield, Massachusetts.
authors.forename: Patty
authors.initials: P
authors.lastname: Samra
authors.affiliation: Baystate Medical Center, Springfield, Massachusetts.
authors.forename: Lynn
authors.initials: L
authors.lastname: Garreffi
authors.affiliation: Baystate Medical Center, Springfield, Massachusetts.
authors.forename: Haiping
authors.initials: H
authors.lastname: Li
authors.affiliation: Baystate Medical Center, Springfield, Massachusetts.
authors.forename: Bonnie
authors.initials: B
authors.lastname: Geld
authors.affiliation: Rhode Island Hospital, Department of Emergency Medicine, Providence, Rhode Island.
authors.forename: Roger Y
authors.initials: RY
authors.lastname: Wu
authors.affiliation: Baystate Medical Center, Springfield, Massachusetts.
authors.forename: Paul
authors.initials: P
authors.lastname: Visintainer
mesh_terms: D000328:Adult; D003441:Crowding; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D010343:Patient Admission / Q000592:standards; D062209:Patient Handoff / Q000458:organization & administration / Q000592:standards; D010865:Pilot Projects