- Email: [email protected]
24 Patterns and Characteristics of Frequent Visitors to the Emergency Department
Research Forum Abstracts A two-sample Wilcoxon rank-sum test was conducted on the data using SAS software (version 9.3) for Windows and R version 2.15.1 for Windows. Results: Two hundred eight patients were recruited. One hundred twenty-one patients were randomized into the control arm and 87 patients into the experimental arm. Thirty-eight patients were excluded from our experimental group because they could not give a urine sample at the time of recruitment. It was determined that there was no statistically significant difference in time to disposition between subjects in the experimental group (mean of 5.25 hours) and subjects in the control group (mean of 5.31 hours), P ¼ .5257. This prospective blinded randomized control study demonstrates that providing urine specimen cups to patients with certain chief complaints does not significantly shorten patients’ time to disposition in the ED.
to the intervention, there were three “near misses” where patients were transported to the floor before report had been called, resulting in poor communication and the potential for patient safety issues. In the three months after our intervention, report called compliance was 98.9% and there were zero patients transported to the floor before report was called. Conclusion: Our study demonstrates that visual cues and enhanced incorporation of a user friendly process in the workflow can improve compliance with ensuring that report is called prior to patient transfer from the ED. This may have a positive impact on physician communication and patient safety during the admission process.
24
Patterns and Characteristics of Frequent Visitors to the Emergency Department
Althagafi M, Alsolamy S, Alsalamah M, Alsaawi A, Alsuirmi K/King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia, Riyadh, Saudi Arabia; Emergency Medicine and Intensive Care Department, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia, Riyadh, Saudi Arabia; King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia, Riyadh, Saudi Arabia
23
Turn That Frown Upside Down: Implementation of a Visual Cue Improves Communication During Emergency Department Inpatient Handoffs
Tanski M, Heilman J, Kusin S, Ma OJ, Pourmand A/Oregon Health & Science University, Portland, OR; George Washington University, Washington, DC
Background: When a patient is admitted to the hospital from the emergency department (ED), their care is transitioned from the emergency physician (EP) to the inpatient physician. This care transition is called a “handoff” and signals that responsibility for the patient has shifted to the admitting team. “Calling report,” or communication between care teams, ensures that patient information, results of diagnostic studies, and patient status are seamlessly communicated with the admitting team. It alerts the team of the patient’s condition and need for ongoing treatment or workup. Failure to consistently perform patient handoffs from the ED to the inpatient unit creates a lapse in patient care and could have a negative impact on patient safety. In the pre-intervention state at our institution, our electronic health record (EHR) was designed with a “report called” button for the EP to click after calling report to the inpatient team. This button was located inside the patient chart, and the chart had to be opened before the physician could click. Additionally, once clicked, users had to change screen views in order to see the “Y” for yes or the “N” for no. This mechanism did not fit well into either physician or nursing workflows and was often overlooked. Patients might be transported to the floor without physician report being called, leading to poor communication and the potential for patient safety errors. Study Objectives: Our primary outcome was to enhance visibility of a new communication signal to improve compliance with doc-to-doc communication prior to transporting the patient to the floor. Our secondary outcome was to evaluate the report called button’s impact on patient safety in ED to inpatient admissions. Methods: We developed a visual cue on the track board to alert nursing staff that doc-to-doc report had been called. When an inpatient bed is requested, the EMR automatically produces a red icon on the trackboard (Figure). This icon alerts the EP and RN that a bed has been requested, but that report is not yet called. When doc-todoc report is called, the EP clicks on the icon and changes the icon to green, signaling that report has been done and the patient is ready for transport. Results: The baseline compliance for the “report called” button being appropriately clicked before implementation of our intervention was 26%. In the three months prior
Volume 66, no. 4s : October 2015
Study Objectives: Frequent visiting to the emergency department (ED) has been recognized as a pattern of ED use that is linked with inefficiency. As frequent ED visitors are a heterogeneous group, further exploration is needed to determine their demographics and visiting characteristics. The purpose of this study is to examine the patterns and characteristics of frequent visitors to the ED. Methods: We conducted a retrospective observational study from January 1, 2013, to December 31, 2013, at the ED of a tertiary care academic medical center with >150,000 annual patient visits. All adult patients who visited the ED 4 or more times per year were included. We divided these patients into 3 groups: occasional visitors (49 visits per year); moderately frequent visitors (10-19 visits per year); and highly frequent visitors (more than 20 visits per year). Results: There were 150,727 visits to the ED, of which 47,399 were made by patients who visited 4 or more times per year (31.4% of total visits). Their mean age was 39 years (SD ¼ 18.2) and most were female (54%). Those assessed at level 4 and 5 of the Canadian Triage and Acuity Scale included 62% of occasional visitors, 59% of moderately frequent visitors, and 58% of highly frequent visitors. Gastrointestinal and orthopaedic concerns comprised 20% and 15% of presentations, respectively. A positive history of cardiac disease increased with the frequency of visits: 9.6% of occasional visitors, 14% of moderately frequent visitors, and 22% of highly frequent visitors. The presence of cardiac disease accompanied by hypertension and a diabetic history also increased with frequency of visits: 23% of occasional visitors and 35% of moderately frequent visitors. Patients with an ED length of stay of more than 4 hours included 36% of occasional visitors, 43% of moderately frequent visitors, and 43% of highly frequent visitors. Patients with an admission rate of more than twice per year comprised 20% of occasional visitors, 38% of moderately frequent visitors, and 51% of highly frequent visitors. Conclusion: Patients who visited the ED 4 or more times per year represent a significant proportion of patients. Their visits constituted almost one third of total ED visits in this study. Interventions need to be designed to address this issue, and further research is warranted to study this phenomenon.
25
The Effect of a Nurse-Initiated Chest Pain Protocol on Disposition Time: A Retrospective Review
Hackman JL, Roth ED, Gaddis ML, Gratton MC/University of Missouri-Kansas City/ Truman Medical Center, Kansas City, MO
Study Objectives: Changes in emergency department (ED) front-end operations have been proposed to decrease patient length of stay (LOS), thereby improving throughput and reducing crowding. Chest pain is one of the most frequent and potentially serious
Annals of Emergency Medicine S9
to the intervention, there were three “near misses” where patients were transported to the floor before report had been called, resulting in poor communication and the potential for patient safety issues. In the three months after our intervention, report called compliance was 98.9% and there were zero patients transported to the floor before report was called. Conclusion: Our study demonstrates that visual cues and enhanced incorporation of a user friendly process in the workflow can improve compliance with ensuring that report is called prior to patient transfer from the ED. This may have a positive impact on physician communication and patient safety during the admission process.
24
Patterns and Characteristics of Frequent Visitors to the Emergency Department
Althagafi M, Alsolamy S, Alsalamah M, Alsaawi A, Alsuirmi K/King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia, Riyadh, Saudi Arabia; Emergency Medicine and Intensive Care Department, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia, Riyadh, Saudi Arabia; King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia, Riyadh, Saudi Arabia
23
Turn That Frown Upside Down: Implementation of a Visual Cue Improves Communication During Emergency Department Inpatient Handoffs
Tanski M, Heilman J, Kusin S, Ma OJ, Pourmand A/Oregon Health & Science University, Portland, OR; George Washington University, Washington, DC
Background: When a patient is admitted to the hospital from the emergency department (ED), their care is transitioned from the emergency physician (EP) to the inpatient physician. This care transition is called a “handoff” and signals that responsibility for the patient has shifted to the admitting team. “Calling report,” or communication between care teams, ensures that patient information, results of diagnostic studies, and patient status are seamlessly communicated with the admitting team. It alerts the team of the patient’s condition and need for ongoing treatment or workup. Failure to consistently perform patient handoffs from the ED to the inpatient unit creates a lapse in patient care and could have a negative impact on patient safety. In the pre-intervention state at our institution, our electronic health record (EHR) was designed with a “report called” button for the EP to click after calling report to the inpatient team. This button was located inside the patient chart, and the chart had to be opened before the physician could click. Additionally, once clicked, users had to change screen views in order to see the “Y” for yes or the “N” for no. This mechanism did not fit well into either physician or nursing workflows and was often overlooked. Patients might be transported to the floor without physician report being called, leading to poor communication and the potential for patient safety errors. Study Objectives: Our primary outcome was to enhance visibility of a new communication signal to improve compliance with doc-to-doc communication prior to transporting the patient to the floor. Our secondary outcome was to evaluate the report called button’s impact on patient safety in ED to inpatient admissions. Methods: We developed a visual cue on the track board to alert nursing staff that doc-to-doc report had been called. When an inpatient bed is requested, the EMR automatically produces a red icon on the trackboard (Figure). This icon alerts the EP and RN that a bed has been requested, but that report is not yet called. When doc-todoc report is called, the EP clicks on the icon and changes the icon to green, signaling that report has been done and the patient is ready for transport. Results: The baseline compliance for the “report called” button being appropriately clicked before implementation of our intervention was 26%. In the three months prior
Volume 66, no. 4s : October 2015
Study Objectives: Frequent visiting to the emergency department (ED) has been recognized as a pattern of ED use that is linked with inefficiency. As frequent ED visitors are a heterogeneous group, further exploration is needed to determine their demographics and visiting characteristics. The purpose of this study is to examine the patterns and characteristics of frequent visitors to the ED. Methods: We conducted a retrospective observational study from January 1, 2013, to December 31, 2013, at the ED of a tertiary care academic medical center with >150,000 annual patient visits. All adult patients who visited the ED 4 or more times per year were included. We divided these patients into 3 groups: occasional visitors (49 visits per year); moderately frequent visitors (10-19 visits per year); and highly frequent visitors (more than 20 visits per year). Results: There were 150,727 visits to the ED, of which 47,399 were made by patients who visited 4 or more times per year (31.4% of total visits). Their mean age was 39 years (SD ¼ 18.2) and most were female (54%). Those assessed at level 4 and 5 of the Canadian Triage and Acuity Scale included 62% of occasional visitors, 59% of moderately frequent visitors, and 58% of highly frequent visitors. Gastrointestinal and orthopaedic concerns comprised 20% and 15% of presentations, respectively. A positive history of cardiac disease increased with the frequency of visits: 9.6% of occasional visitors, 14% of moderately frequent visitors, and 22% of highly frequent visitors. The presence of cardiac disease accompanied by hypertension and a diabetic history also increased with frequency of visits: 23% of occasional visitors and 35% of moderately frequent visitors. Patients with an ED length of stay of more than 4 hours included 36% of occasional visitors, 43% of moderately frequent visitors, and 43% of highly frequent visitors. Patients with an admission rate of more than twice per year comprised 20% of occasional visitors, 38% of moderately frequent visitors, and 51% of highly frequent visitors. Conclusion: Patients who visited the ED 4 or more times per year represent a significant proportion of patients. Their visits constituted almost one third of total ED visits in this study. Interventions need to be designed to address this issue, and further research is warranted to study this phenomenon.
25
The Effect of a Nurse-Initiated Chest Pain Protocol on Disposition Time: A Retrospective Review
Hackman JL, Roth ED, Gaddis ML, Gratton MC/University of Missouri-Kansas City/ Truman Medical Center, Kansas City, MO
Study Objectives: Changes in emergency department (ED) front-end operations have been proposed to decrease patient length of stay (LOS), thereby improving throughput and reducing crowding. Chest pain is one of the most frequent and potentially serious
Annals of Emergency Medicine S9