[ANSWER]NUR342 Assessment 2 Discussion Post Original Post: Reducing Length of Stay in the Emergency Room

TASK DESCRIPTION

Reducing Length of Stay in the Emergency Room

Prolonged length of stay (LOS) in the emergency department (ED) is a problematic clinical issue, with many patients waiting up to 6 hours or more in some cases (Mahsanlar et al., 2014). In other cases, patients can even leave the ED without being seen (Arya et al., 2013).

Attributable to factors such as overcrowding and staff shortage in the ED, prolonged LOS can result in devastating outcomes for patients, including delays in administration of treatment, adverse events, and even death in some cases (Arya et al., 2013; Burgess et al., 2018; Vermeulen et al., 2016). Furthermore, prolonged LOS has been found to be a significant predictor of patient dissatisfaction in the ED context (Parker & Marco, 2014). This makes LOS in ED care a topical issue. The negative patient outcomes and potentially life-threatening outcomes associated with prolonged LOS informed the choice of this issue.

Reducing Length of Stay in the Emergency Room

Research has been conducted to offer evidence-based solutions to the problem of prolonged LOS in the ED setting. One intervention for the problem is the Emergency Severity Index (ESI), a patient flow management tool that helps in segmenting patients based on the severity of their status when presenting to the ED (Arya et al., 2013).

A closely related intervention is the ED wait time strategy, which encompasses an array of initiatives, including ER process improvement, setting targets for ED LOS, as well as pay-for-performance incentives and formal reporting of ED wait times (Vermeulen et al., 2016). Following from this background, the following PICO question is formulated in relation to addressing the identified problem: in ED patients, does the ESI compared to the ED wait time strategy reduce LOS?

Reducing Length of Stay in the Emergency Room

Two articles that are useful for answering the PICO question have been identified. One article is authored by Arya et al. (2013). In this article, the authors report the findings of a retrospective study they conducted to examine the effectiveness of the ESI in reducing LOS in the ED. The study was conducted from 2010 to 2011 at an urban-located ED that serves more than 70,000 patients annually.

Following the implementation of the ESI, the average LOS decreased from 2.58 hours to 2.43 hours, representing a 5.9% reduction. This reduction appears trivial, but the study demonstrates the usefulness of the ESI in enhancing patient flow management and, hence, reducing LOS in the ED. Arya et al.’s (2013) study is therefore helpful in answering the PICO question. 

Reducing Length of Stay in the Emergency Room

The second article is by Vermeulen et al. (2016), a retrospective study conducted over a period of 3 years (2008-2010) to examine the effect of the ED wait time strategy on ED LOS and quality outcomes in 24 hospitals in Ontario, Canada. The study particularly involved comparing quality outcomes in two groups of hospitals: the first group comprised 11 hospitals that had recorded a significant improvement in ED LOS following the adoption of the strategy and the second group included 13 hospitals that had recorded an insignificant improvement.

In the first group, an improvement of 15-26% had been recorded on average. This study suggests that the ED wait time strategy is useful in reducing ED LOS. Thus, the study is helpful in answering the PICO question as it offers a basis of comparing the ESI intervention with the ED wait time strategy. [ Reducing Length of Stay in the Emergency Room ]  

References

Arya, R., Wei, G., McCoy, J., Crane, J., Ohman-Strickland, P., & Eisenstein, R. (2013). Decreasing length of stay in the emergency with a split emergency severity index 3 patient flow model. Academic Emergency Medicine, 20, 1171-1179. doi: 10.1111/acem.12249

Burgess, L. Hines, S., & Kynoch, K. (2018). Association between emergency department length of stay and patient outcomes. JBI Database of Systematic Reviews and Implementation Reports, 16(6), 1361-1366. doi: 10.11124/JBISRIR-2017-003568

Mahsanlar, Y., Parlak, I., Yolcu, S., Akay, S., Demirtas, Y., & Eryigit, V. (2014). Factors affecting the length of stay of patients in emergency department observation units at teaching and research hospitals in Turkey. Turkish Journal of Emergency Medicine, 14(1), 3-8. doi: 10.5505/1304.7361.2014.5822

Parker, B., & Marco, C. (2014). Emergency department length of stay: Accuracy of patient estimates. Western Journal of Emergency Medicine, 15(2), 170-175.

Vermeulen, M., Guttman, A., Stukel, T., Kachra, A., Sivilotti, M., Rowe, B., Dreyer, J., Bell, R., & Schull, M. (2016). Are reductions in emergency department length of stay associated with improvements in quality of care? A difference-in-differences analysis. BMJ Quality & Safety, 25, 489-498. http://dx.doi.org/10.1136/bmjqs2015-004189

Topic: Reducing Length of Stay in the Emergency Room

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