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domingo, 17 de abril de 2016

Emergency Department Flow

emDocs - April 17, 2016 - Authors: Lee Y., Williamson K.
Edited by Robertson J and Koyfman A
"Why is Emergency Department Flow Important?
Emergency department (ED) overcrowding is a nationwide problem. Overcrowding leads to suboptimal patient care as there are limited resources to handle it. Ironically, in many ways, the burden of overcrowding is partially due to the successful delivery of emergency care. Due to the immense growth of emergency rooms to emergency departments, many patients now see the ED as the best place for initial care of injuries and/or illnesses. In addition, the ED serves a unique role within the community as a safety net. As a safety net, the ED is a place where uninsured patients can receive care, and even a place where patients can receive care and testing when their primary care physicians’ offices are closed or lack the appropriate resources for care delivery. When patient demand exceeds the ability of an ED to function optimally, the consequences are drastic and can include loss of revenue and compromise in the quality of care. The local community may develop feelings of distrust as well. Approximately 50% of sentinel events causing serious injury or death occur in the emergency department, and according to the Joint Commission, approximately one third of these are related to overcrowding. The risk of death is also higher during times of ED overcrowding. When a patient receives ED care during a period of overcrowding, he or she has a relative risk of in-hospital death of 1.34 within 10 days of admission. Overcrowding also leads to increased ambulance diversion, which further prolongs the time that a patient can receive potentially life-saving care. In addition, for the hospital, increased wait times increase the number of “left before seen” patients which causes significant revenue loss. A one-hour reduction in ED boarding can lead to approximately nine thousand dollars in additional revenue for the hospital...
Summary
ED crowding is an issue that continues to evolve and will impact nearly all emergency physicians. The ED is the location in the hospital that feels the greatest stress from capacity issues hospital-wide. Thus, emergency providers are uniquely positioned to have the greatest impact in flow improvement initiatives. Initiatives can be as small as improvements in our daily workflow to as large as hospital-wide changes that involve multiple specialties. Improving patient flow should be continuously addressed. By improving flow through the ED, we can help our patients by decreasing medical errors, decreasing hospital lengths of stay, and improving our own workplace experience.