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The Long-Term Effect of an Independent Capacity Protocol on Emergency Department Length of Stay: A before and after Study.

Cha WC, Song KJ, Cho JS, Singer AJ, Shin SD - Yonsei Med. J. (2015)

Bottom Line: 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).Implementation of the ICP was associated with a sustainable reduction in ED LOS and time to admission over a six-year period.

View Article: PubMed Central - PubMed

Affiliation: Department of Emergency Medicine, Samsung Medical Center, Seoul, Korea.

ABSTRACT

Purpose: 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.

Materials and 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).

Conclusion: Implementation of the ICP was associated with a sustainable reduction in ED LOS and time to admission over a six-year period.

No MeSH data available.


Related in: MedlinePlus

Conceptualized emergency department (ED) flow before and after introduction of the independent-capacity protocol. Dashed lines represent transfers from specific wards to other hospitals that were not analyzed in this study due to small numbers. Clear arrows represent discharges to home (from Cha WC, et al. Acad Emerg Med 2009;16:1277-83).15
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Figure 1: Conceptualized emergency department (ED) flow before and after introduction of the independent-capacity protocol. Dashed lines represent transfers from specific wards to other hospitals that were not analyzed in this study due to small numbers. Clear arrows represent discharges to home (from Cha WC, et al. Acad Emerg Med 2009;16:1277-83).15

Mentions: The ICP was designed to help reduce ED crowding by augmenting the output capacity at regional medical centers. This protocol gave emergency physicians more responsibility and authority over patient disposition. The ICP also converted the ED into a temporary, nonspecific ward that can care for any patient for a period of up to 48 hours. During this time period emergency physicians were assisted by specialists and transfer coordinators in determining patient disposition. When no local beds were available at the study institution and the patient's condition allowed, patients were transferred to a surrounding community hospital based on a case-by case determination and inter-facility agreements and protocols. The general principles of the ICP are presented in Fig. 1.15


The Long-Term Effect of an Independent Capacity Protocol on Emergency Department Length of Stay: A before and after Study.

Cha WC, Song KJ, Cho JS, Singer AJ, Shin SD - Yonsei Med. J. (2015)

Conceptualized emergency department (ED) flow before and after introduction of the independent-capacity protocol. Dashed lines represent transfers from specific wards to other hospitals that were not analyzed in this study due to small numbers. Clear arrows represent discharges to home (from Cha WC, et al. Acad Emerg Med 2009;16:1277-83).15
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4541678&req=5

Figure 1: Conceptualized emergency department (ED) flow before and after introduction of the independent-capacity protocol. Dashed lines represent transfers from specific wards to other hospitals that were not analyzed in this study due to small numbers. Clear arrows represent discharges to home (from Cha WC, et al. Acad Emerg Med 2009;16:1277-83).15
Mentions: The ICP was designed to help reduce ED crowding by augmenting the output capacity at regional medical centers. This protocol gave emergency physicians more responsibility and authority over patient disposition. The ICP also converted the ED into a temporary, nonspecific ward that can care for any patient for a period of up to 48 hours. During this time period emergency physicians were assisted by specialists and transfer coordinators in determining patient disposition. When no local beds were available at the study institution and the patient's condition allowed, patients were transferred to a surrounding community hospital based on a case-by case determination and inter-facility agreements and protocols. The general principles of the ICP are presented in Fig. 1.15

Bottom Line: 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).Implementation of the ICP was associated with a sustainable reduction in ED LOS and time to admission over a six-year period.

View Article: PubMed Central - PubMed

Affiliation: Department of Emergency Medicine, Samsung Medical Center, Seoul, Korea.

ABSTRACT

Purpose: 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.

Materials and 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).

Conclusion: Implementation of the ICP was associated with a sustainable reduction in ED LOS and time to admission over a six-year period.

No MeSH data available.


Related in: MedlinePlus