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143 Vital Signs as Predictors of Rapid Response Team Activations Within Twelve Hours of Admission From the Emergency Department
Research Forum Abstracts documented electronically within discrete fields in the EHR. All interventions and clinical activities from January 1, 2015 through March 31, 2015 were abstracted via electronic data pull for further analysis by a trained reviewer. All data were analyzed descriptively. Results: A total of 3739 interventions and clinical activities were documented by EM pharmacists, with a mean of 41.5 13.3 (mean standard deviation) documented per day. Categorization of interventions and clinical activities is summarized in Table 1. Of the 1165 drug therapy recommendations, a total of 986 were linked within the EHR to a therapeutic class of medication. For these 986 drug therapy recommendations, the most frequently implicated therapeutic classes were antimicrobial agents (31.9%), cardiovascular agents (16.2%), analgesic agents (12.6%), central nervous system agents (8.1%), and antihyperglycemic agents (6.2%). EM pharmacists documented interventions for 11.7% of emergency department patients during the study period. Conclusion: EM pharmacists documented multiple types of interventions and clinical activities in a tertiary medical center with 66% of documentation relating to drug therapy recommendations and medication histories. These documented interventions demonstrate the role of EM pharmacists in optimizing medication therapy to improve patient safety.
144
Effect of Nursing Patient Flow Coordinators on Length of Stay of Boarded Patients in Emergency Department
Alsolamy S, Al Rajhi K, Al Mutairi N, AlSaawi A, Minot D, Alrasheed R, Alassim N, Alotaibi B, Hijazi R/King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia, Riyadh, Saudi Arabia; King Fahd Medical City, Riyadh, Saudi Arabia
143
Vital Signs as Predictors of Rapid Response Team Activations Within Twelve Hours of Admission From the Emergency Department
Walston J, Bellew SD, Bellolio MF, Cabrera D, Lohse CM/Mayo Clinic, Rochester, MN
Study Objective: Rapid-response teams (RRTs) are interdisciplinary groups created to rapidly assess and treat patients with unexpected clinical deterioration in nonintensive care unit (ICU) beds. It has been suggested that emergency department (ED) disposition should take into consideration vital signs (VS) at the time of hospital admission. We aimed to predict which patients will have RRT activation within 12 hours of admission based on their ED VS. Methods: We conducted a case-control study of patients presenting from January 2009 to December 2013 to a tertiary ED who subsequently had RRT activation within 12 hours of admission. The records of patients 18 years and older admitted to a non-ICU setting were reviewed to obtain VS at the time of ED departure. Each of the 474 RRT activation cases was matched to a control by age, sex, and ED diagnosis. Controls presented to the ED during the same time period, were admitted, but did not have RRT activation. VS were evaluated using cut points (lowest 10%, middle 80% and highest 10%) based on the distribution of VS for all 948 patients and were compared between cases and controls using conditional logistic regression. Results: Vital signs have a bimodal distribution, where the lowest and the highest extremes are concerning. Cutoff comparison between cases and controls is shown in Table 1. Patients with RRT activations were more likely to have a heart rate > 111 bpm (OR 2.76; CI 1.65-4.60), have a sBP 157 mmHg (OR 1.82; 1.19-2.80), have a respiratory rate >24 (OR 4.15; CI 2.44-7.07) and have an oxygen saturation <93% (OR 2.29; CI 1.43-3.67) at the time of ED departure. Conclusion: After matching for age, sex, and ED diagnosis, abnormal VS at the time of ED departure are predictive of RRT activation within 12 hours of admission. However, an ideal set of VS cut points to trigger a change in ED disposition remain unclear.
Volume 66, no. 4s : October 2015
Study Objectives: Hospital crowding and the resultant long emergency department (ED) length of stay (LOS) for boarded patients have been associated with poor patient outcomes. An analysis of prolonged boarding times found that charge nurses who were responsible for managing ED operations and prioritizing patients awaiting admission were overwhelmed with duties. The complex communication tasks between the ED, admission officers, and various inpatient units needed improvement. We introduced a new nursing patient flow coordinator (NPFC) position. The NPFCs aimed to improve patient flow within the ED; their duties included prioritizing patients awaiting admission by coordinating with admission officers and inpatient units, responding to ED bed shortages, ensuring prompt patient transfers once a bed had been assigned, and coordinating the opening, closing, and staffing of overflow areas. The purpose of this study is to determine the impact of the NPFC position on ED crowding by measuring the LOS for boarded patients. Methods: This retrospective, observational, pre -post study was conducted at an emergency medicine department with 115 beds, five distinct clinical areas, and more than 150,000 annual visits in a 1,000-bed academic tertiary care center. We compared the LOS of boarded patients before the introduction of the NPFC role (January 2011 through March 2011), with the LOS after the introduction of the NPFC role (January 2013 through March 2013). Results: A total of 60,904 patients were enrolled; 29,129 patients in period before the intervention, 31,775 in patients period after the intervention. The median LOS of boarded patients was higher in the period after implementation (18.7h, Interquartile range 22.0) than before the implementation of the NPFC [(14.7h, Interquartile range 27.4); P < .0005]. However, the number of ED visits after implementation increased by 4%, and the rate of admissions from the ED increased from 10.1% to 11.4% as well. The hospital operation indicators were nonsignificant change in the two periods; inpatient bed turnover before and after the implementation were 3.9 and 3.6 patients/bed/month respectively while inpatient units bed occupancy rate was constant at 92%. Conclusion: Despite subjective improvement in nurse’s satisfaction, the NPFC program did not achieve a positive effect on LOS for boarded patients. This may have been influenced by worsening hospital crowding indicators. This intervention should have been coupled with improvements in ED input and output processes in order to improve the impact on the LOS of boarded patients.
145
Patient Safety Culture in the Emergency Department
Wei E, Bassin B, Santen S, Sharp B, Hopson L, Somand D, Fischer J, Hemphill R/University of Southern California, Los Angeles, CA; University of Michigan, Ann Arbor, MI; University of Wisconsin, Madison, WI; VA Hospital, Ann Arbor, MI
Background: The Institute of Medicine (IOM) has declared that the goal of delivering fundamentally safe care requires commitment from all stakeholders to a
Annals of Emergency Medicine S51
144
Effect of Nursing Patient Flow Coordinators on Length of Stay of Boarded Patients in Emergency Department
Alsolamy S, Al Rajhi K, Al Mutairi N, AlSaawi A, Minot D, Alrasheed R, Alassim N, Alotaibi B, Hijazi R/King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia, Riyadh, Saudi Arabia; King Fahd Medical City, Riyadh, Saudi Arabia
143
Vital Signs as Predictors of Rapid Response Team Activations Within Twelve Hours of Admission From the Emergency Department
Walston J, Bellew SD, Bellolio MF, Cabrera D, Lohse CM/Mayo Clinic, Rochester, MN
Study Objective: Rapid-response teams (RRTs) are interdisciplinary groups created to rapidly assess and treat patients with unexpected clinical deterioration in nonintensive care unit (ICU) beds. It has been suggested that emergency department (ED) disposition should take into consideration vital signs (VS) at the time of hospital admission. We aimed to predict which patients will have RRT activation within 12 hours of admission based on their ED VS. Methods: We conducted a case-control study of patients presenting from January 2009 to December 2013 to a tertiary ED who subsequently had RRT activation within 12 hours of admission. The records of patients 18 years and older admitted to a non-ICU setting were reviewed to obtain VS at the time of ED departure. Each of the 474 RRT activation cases was matched to a control by age, sex, and ED diagnosis. Controls presented to the ED during the same time period, were admitted, but did not have RRT activation. VS were evaluated using cut points (lowest 10%, middle 80% and highest 10%) based on the distribution of VS for all 948 patients and were compared between cases and controls using conditional logistic regression. Results: Vital signs have a bimodal distribution, where the lowest and the highest extremes are concerning. Cutoff comparison between cases and controls is shown in Table 1. Patients with RRT activations were more likely to have a heart rate > 111 bpm (OR 2.76; CI 1.65-4.60), have a sBP 157 mmHg (OR 1.82; 1.19-2.80), have a respiratory rate >24 (OR 4.15; CI 2.44-7.07) and have an oxygen saturation <93% (OR 2.29; CI 1.43-3.67) at the time of ED departure. Conclusion: After matching for age, sex, and ED diagnosis, abnormal VS at the time of ED departure are predictive of RRT activation within 12 hours of admission. However, an ideal set of VS cut points to trigger a change in ED disposition remain unclear.
Volume 66, no. 4s : October 2015
Study Objectives: Hospital crowding and the resultant long emergency department (ED) length of stay (LOS) for boarded patients have been associated with poor patient outcomes. An analysis of prolonged boarding times found that charge nurses who were responsible for managing ED operations and prioritizing patients awaiting admission were overwhelmed with duties. The complex communication tasks between the ED, admission officers, and various inpatient units needed improvement. We introduced a new nursing patient flow coordinator (NPFC) position. The NPFCs aimed to improve patient flow within the ED; their duties included prioritizing patients awaiting admission by coordinating with admission officers and inpatient units, responding to ED bed shortages, ensuring prompt patient transfers once a bed had been assigned, and coordinating the opening, closing, and staffing of overflow areas. The purpose of this study is to determine the impact of the NPFC position on ED crowding by measuring the LOS for boarded patients. Methods: This retrospective, observational, pre -post study was conducted at an emergency medicine department with 115 beds, five distinct clinical areas, and more than 150,000 annual visits in a 1,000-bed academic tertiary care center. We compared the LOS of boarded patients before the introduction of the NPFC role (January 2011 through March 2011), with the LOS after the introduction of the NPFC role (January 2013 through March 2013). Results: A total of 60,904 patients were enrolled; 29,129 patients in period before the intervention, 31,775 in patients period after the intervention. The median LOS of boarded patients was higher in the period after implementation (18.7h, Interquartile range 22.0) than before the implementation of the NPFC [(14.7h, Interquartile range 27.4); P < .0005]. However, the number of ED visits after implementation increased by 4%, and the rate of admissions from the ED increased from 10.1% to 11.4% as well. The hospital operation indicators were nonsignificant change in the two periods; inpatient bed turnover before and after the implementation were 3.9 and 3.6 patients/bed/month respectively while inpatient units bed occupancy rate was constant at 92%. Conclusion: Despite subjective improvement in nurse’s satisfaction, the NPFC program did not achieve a positive effect on LOS for boarded patients. This may have been influenced by worsening hospital crowding indicators. This intervention should have been coupled with improvements in ED input and output processes in order to improve the impact on the LOS of boarded patients.
145
Patient Safety Culture in the Emergency Department
Wei E, Bassin B, Santen S, Sharp B, Hopson L, Somand D, Fischer J, Hemphill R/University of Southern California, Los Angeles, CA; University of Michigan, Ann Arbor, MI; University of Wisconsin, Madison, WI; VA Hospital, Ann Arbor, MI
Background: The Institute of Medicine (IOM) has declared that the goal of delivering fundamentally safe care requires commitment from all stakeholders to a
Annals of Emergency Medicine S51