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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

Waiting time of admitted patients by year. After the intervention, the intercept decreased from 33.6 to 31.1 hours (difference: 2.44, 95% CI: 0.84 to 4.05) (p=0.003). The slope decreased from 0.45 to -0.54 hour/week (difference: 0.100, 95% CI: 0.081 to 0.12) (p<0.001). IQR, interquatile range; SD, standard deviation; CI, confidence interval; ED, emergency department; LOS, length of stay.
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Figure 5: Waiting time of admitted patients by year. After the intervention, the intercept decreased from 33.6 to 31.1 hours (difference: 2.44, 95% CI: 0.84 to 4.05) (p=0.003). The slope decreased from 0.45 to -0.54 hour/week (difference: 0.100, 95% CI: 0.081 to 0.12) (p<0.001). IQR, interquatile range; SD, standard deviation; CI, confidence interval; ED, emergency department; LOS, length of stay.

Mentions: Figs. 2,3,4,5 summarize the results of the piecewise regression. The piecewise regression compares the y-intercept and slope before and after implementation of the ICP. ED visits increased continuously (Fig. 2). After the intervention, the intercept changed from 119.1 to 115.1 (difference: 3.39, 95% CI: -1.43 to 8.21) (p=0.17) and was not statistically significant. The slope increased from 0.146 to 0.205 daily visits/week (difference: 0.060, 95% CI: 0.004 to 0.116) (p=0.04). The transfer rate from the emergency ward, which implies the community resource utilization rate, showed an overall increasing trend, as presented in Table 2. After implementing the ICP, the intercept increased from 3.21% to 5.50% (difference: 2.29, 95% CI: 0.27 to 4.31) (p=0.03). The slope increased from 0.012% to 0.019% per week (difference: 0.0075, 95% CI: -0.016 to 0.031) (p=0.53) but was not statistically significant (Fig. 3). The overall ED LOS demonstrated a decreasing trend (Fig. 4). After the intervention, the intercept dropped from 8.51 to 7.98 hours (difference: 0.52, 95% CI: 0.04 to 1.01) (p=0.03), and the slope decreased from -0.011 to -0.018 hours/week (difference: 0.0069, 95% CI: 0.0012 to 0.013) (p=0.02). As demonstrated in Fig. 5, a notable change was seen in the mean time waiting for admission. After the intervention, the intercept decreased from 33.6 to 31.1 hours (difference: 2.44, 95% CI: 0.84 to 4.05) (p=0.003) and the slope decreased from 0.45 to -0.54 hour/week (difference: 0.100, 95% CI: 0.081 to 0.18) (p<0.001).


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)

Waiting time of admitted patients by year. After the intervention, the intercept decreased from 33.6 to 31.1 hours (difference: 2.44, 95% CI: 0.84 to 4.05) (p=0.003). The slope decreased from 0.45 to -0.54 hour/week (difference: 0.100, 95% CI: 0.081 to 0.12) (p<0.001). IQR, interquatile range; SD, standard deviation; CI, confidence interval; ED, emergency department; LOS, length of stay.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 5: Waiting time of admitted patients by year. After the intervention, the intercept decreased from 33.6 to 31.1 hours (difference: 2.44, 95% CI: 0.84 to 4.05) (p=0.003). The slope decreased from 0.45 to -0.54 hour/week (difference: 0.100, 95% CI: 0.081 to 0.12) (p<0.001). IQR, interquatile range; SD, standard deviation; CI, confidence interval; ED, emergency department; LOS, length of stay.
Mentions: Figs. 2,3,4,5 summarize the results of the piecewise regression. The piecewise regression compares the y-intercept and slope before and after implementation of the ICP. ED visits increased continuously (Fig. 2). After the intervention, the intercept changed from 119.1 to 115.1 (difference: 3.39, 95% CI: -1.43 to 8.21) (p=0.17) and was not statistically significant. The slope increased from 0.146 to 0.205 daily visits/week (difference: 0.060, 95% CI: 0.004 to 0.116) (p=0.04). The transfer rate from the emergency ward, which implies the community resource utilization rate, showed an overall increasing trend, as presented in Table 2. After implementing the ICP, the intercept increased from 3.21% to 5.50% (difference: 2.29, 95% CI: 0.27 to 4.31) (p=0.03). The slope increased from 0.012% to 0.019% per week (difference: 0.0075, 95% CI: -0.016 to 0.031) (p=0.53) but was not statistically significant (Fig. 3). The overall ED LOS demonstrated a decreasing trend (Fig. 4). After the intervention, the intercept dropped from 8.51 to 7.98 hours (difference: 0.52, 95% CI: 0.04 to 1.01) (p=0.03), and the slope decreased from -0.011 to -0.018 hours/week (difference: 0.0069, 95% CI: 0.0012 to 0.013) (p=0.02). As demonstrated in Fig. 5, a notable change was seen in the mean time waiting for admission. After the intervention, the intercept decreased from 33.6 to 31.1 hours (difference: 2.44, 95% CI: 0.84 to 4.05) (p=0.003) and the slope decreased from 0.45 to -0.54 hour/week (difference: 0.100, 95% CI: 0.081 to 0.18) (p<0.001).

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