ED Bed Coordinator Speeds Patient Admissions

Diana Phillips

December 30, 2014

The implementation of an emergency department (ED) bed coordination program can reduce ED boarding time and hospital overcrowding, according to a new a study.

In a comparison of patient flow metrics before and after the Harbor-UCLA Medical Center in Torrance, California, repurposed an ED nursing position to a bed coordinator on October 15, 2013, the intervention was associated with significant reductions in the time spent in the ED between the decision to admit and the actual move to a room (boarding time). The intervention also reduced periods of dangerous and critical overcrowding at the public hospital and level 1 trauma center, Ross J. Fleishman, MD, from the medical center's Department of Emergency Medicine, and colleagues report in an article published online December 29 in JAMA Internal Medicine.

To assist physicians in identifying inpatients early in the day who could be transferred to a lower level of care, the bed coordinator monitored all beds and applied appropriate use criteria to evaluate the possibility of transfer, the authors write.

During the period of study from November 1, 2012, through March 14, 2014, 4597 patients were admitted from the ED to a step-down unit (SDU), including 2948 baseline patients and 1649 intervention patients. "After adjustment by multivariable analysis, the intervention was associated with less boarding time, on average, by 100 minutes per patient admitted to a bed in the SDU," the authors report, noting that hour of admission, hospital census, SDU census, SDU nurse staffing per shift, and admission to a surgical vs medical service also significantly predicted boarding time.

In a separate analysis of all admissions, including to the wards and intensive care units, "the intervention was associated with a 30-minute decrease in boarding time per patient overall," the authors write.

The intervention also alleviated overcrowding, with a decrease from a median of 94 (baseline period) to 32 hours (intervention period) per month in the time during which there was dangerous hospital overcrowding, and a decrease from a median of 33 to 0 hours per month during which there was critical hospital overcrowding. "The time during which there was dangerous overcrowding per month tracked closely to the hospital census in the baseline (R 2 = 0.6; P = .01) but not to the interventional period (R 2 = 0.3; P = .30)," they report.

Considering the large number of patients evaluated and the universal nature of the patient flow problems encountered at the hospital, the results from the single-center study "are likely generalizable, but perhaps to varying degrees, depending on the severity of the baseline patient flow problems at individual institutions," the authors write.

The authors have disclosed no relevant financial relationships.

JAMA Intern Med. Published online December 29, 2014. Extract

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