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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

Comparison of trend of admission waiting time between study hospital emergency department and other level-1 emergency departments. The top line represents the trend of the study hospital, while the lower line represents the trend of the 15 other level-1 emergency centers.
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Figure 6: Comparison of trend of admission waiting time between study hospital emergency department and other level-1 emergency departments. The top line represents the trend of the study hospital, while the lower line represents the trend of the 15 other level-1 emergency centers.

Mentions: In order to compare outcomes in the study institution with those in the other 15 level-1 centers in the NEDIS database, administrative data, including ED LOS and admission waiting time, were collected. Overall, 2892440 data points were evaluated over a duration of 65 months. Similarly, a piecewise regression was carried out. Before the intervention, the slope of the study hospital was 0.0547 hour/week (95% CI: 0.039 to 0.070). This was significantly higher than the slope of the other hospitals, which was 0.0064 hour/week (95% CI: 0.0020 to 0.011). However, after the intervention, the slope of the study hospital was -0.0642 hour/week (95% CI: -0.078 to -0.051), which was significantly lower than the other centers' slope of -0.0080 hour/week (95% CI: -0.012 to -0.0042) (Fig. 6).


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)

Comparison of trend of admission waiting time between study hospital emergency department and other level-1 emergency departments. The top line represents the trend of the study hospital, while the lower line represents the trend of the 15 other level-1 emergency centers.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 6: Comparison of trend of admission waiting time between study hospital emergency department and other level-1 emergency departments. The top line represents the trend of the study hospital, while the lower line represents the trend of the 15 other level-1 emergency centers.
Mentions: In order to compare outcomes in the study institution with those in the other 15 level-1 centers in the NEDIS database, administrative data, including ED LOS and admission waiting time, were collected. Overall, 2892440 data points were evaluated over a duration of 65 months. Similarly, a piecewise regression was carried out. Before the intervention, the slope of the study hospital was 0.0547 hour/week (95% CI: 0.039 to 0.070). This was significantly higher than the slope of the other hospitals, which was 0.0064 hour/week (95% CI: 0.0020 to 0.011). However, after the intervention, the slope of the study hospital was -0.0642 hour/week (95% CI: -0.078 to -0.051), which was significantly lower than the other centers' slope of -0.0080 hour/week (95% CI: -0.012 to -0.0042) (Fig. 6).

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