title: The Long-Term Effect of an Independent Capacity Protocol on Emergency Department Length of Stay: A before and after Study.
abstract: OBJECTIVE
  In this study, we determined the long-term effects of the Independent Capacity Protocol (ICP), in which the emergency department (ED) is temporarily used to stabilize patients, followed by transfer of patients to other facilities when necessary, on crowding metrics.
  
  
  METHODS
  A before and after study design was used to determine the effects of the ICP on patient outcomes in an academic, urban, tertiary care hospital. The ICP was introduced on July 1, 2007 and the before period included patients presenting to the ED from January 1, 2005 to June 31, 2007. The after period began three months after implementing the ICP from October 1, 2007 to December 31, 2010. The main outcomes were the ED length of stay (LOS) and the total hospital LOS of admitted patients. The mean number of monthly ED visits and the rate of inter-facility transfers between emergency departments were also determined. A piecewise regression analysis, according to observation time intervals, was used to determine the effect of the ICP on the outcomes.
  
  
  RESULTS
  During the study period the number of ED visits significantly increased. The intercept for overall ED LOS after intervention from the before-period decreased from 8.51 to 7.98 hours [difference 0.52, 95% confidence interval (CI): 0.04 to 1.01] (p=0.03), and the slope decreased from -0.0110 to -0.0179 hour/week (difference 0.0069, 95% CI: 0.0012 to 0.0125) (p=0.02).
  
  
  CONCLUSIONS
  Implementation of the ICP was associated with a sustainable reduction in ED LOS and time to admission over a six-year period.
authors.affiliation: Department of Emergency Medicine, Samsung Medical Center, Seoul, Korea.
authors.forename: Won Chul
authors.initials: WC
authors.lastname: Cha
authors.affiliation: Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Kyoung Jun
authors.initials: KJ
authors.lastname: Song
authors.affiliation: Department of Emergency Medicine, Gachon University Gil Hospital, Seoul, Korea.
authors.forename: Jin Sung
authors.initials: JS
authors.lastname: Cho
authors.affiliation: Department of Emergency Medicine, Stony Brook University, NY, USA.
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Singer
authors.affiliation: Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea. shinsangdo@medimail.co.kr.
authors.forename: Sang Do
authors.initials: SD
authors.lastname: Shin
mesh_terms: D000368:Aged; D002985:Clinical Protocols; D003441:Crowding; D017598:Efficiency, Organizational; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000706:statistics & numerical data; D005260:Female; D006752:Hospital Planning / Q000379:methods*; D006786:Hospitals, Urban / Q000458:organization & administration* / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D010343:Patient Admission / Q000706:statistics & numerical data; D010360:Patient Transfer / Q000706:statistics & numerical data; D012044:Regression Analysis; D013995:Time; D013997:Time Factors; D014218:Triage
keywords: Crowding; clinical protocol; health resources