Reducing Patient Placement Errors in ED Admissions
Reducing Patient Placement Errors in ED Admissions
We encountered a number of barriers during this pilot. Suboptimal staffing of PPMs and large volumes of calls at once to the hospitalist led to delay in call backs to EPs. The ED staff perceived this as adding delays to patient flow and care, and a waste of EP time may have been a hidden cost as well. PPMs may not have been able to determine if a "lateral" transfer to a higher level of care was due to progression of disease that could not have been predicted in the ED – rather than an assignment error in placement. We believe that this reason for "lateral" transfer occurred in only a small minority of cases. Moreover, we have no reason to believe that the number of patients who were "lateral" transfers because of deterioration in condition was greater in number during the control periods than during the study periods.
We did not quantify delays experienced in the admissions process during the study periods; however, the perception of the EPs was that addition of portable cell phones in the second pilot significantly alleviated interference with their workflow and prevented delays in call backs from hospitalists. Inpatient occupancy was measured during the control and study periods, but we did not measure inpatient LOS. We also did not measure patient, nursing or physician satisfaction with these changes, but expect patient satisfaction to increase with fewer "in-house" transfers needed after admission from the ED. We did not perform a formal cost-effectiveness analysis.
Limitations
We encountered a number of barriers during this pilot. Suboptimal staffing of PPMs and large volumes of calls at once to the hospitalist led to delay in call backs to EPs. The ED staff perceived this as adding delays to patient flow and care, and a waste of EP time may have been a hidden cost as well. PPMs may not have been able to determine if a "lateral" transfer to a higher level of care was due to progression of disease that could not have been predicted in the ED – rather than an assignment error in placement. We believe that this reason for "lateral" transfer occurred in only a small minority of cases. Moreover, we have no reason to believe that the number of patients who were "lateral" transfers because of deterioration in condition was greater in number during the control periods than during the study periods.
We did not quantify delays experienced in the admissions process during the study periods; however, the perception of the EPs was that addition of portable cell phones in the second pilot significantly alleviated interference with their workflow and prevented delays in call backs from hospitalists. Inpatient occupancy was measured during the control and study periods, but we did not measure inpatient LOS. We also did not measure patient, nursing or physician satisfaction with these changes, but expect patient satisfaction to increase with fewer "in-house" transfers needed after admission from the ED. We did not perform a formal cost-effectiveness analysis.
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