Abated crowding by fast-tracking the Throughput component of the ED for patients in no need of hospitalization with competency managed personnel

Abstract

Background Emergency department (ED) crowding is a major patient safety concern and has a negative impact on healthcare systems and healthcare providers. We hypothesized that it would be feasible to control crowding by employing a multifaceted approach consisting of systematically fast-tracking patients who are mostly not in need of a hospital stay as assessed by an initial nurse and treated by decision competent physicians. Methods Data from 108532 patients registered in a secondary care ED from the 4t^th quarter of 2021 to the 4^th quarter of 2023 was drawn from the electronic health record’s data warehouse using the SAP Web Intelligence tool and processed in the Python programming language. Crowding was compared before and after ED transformation from a uniform department into a high flow (α) and a low flow (β) section with patient placement in gurneys/chairs or beds, respectively. Patients putatively not in need of hospitalization were identified by nurse, placed in in the α setting and assessed and treated by decision competent physicians. Incidence of crowding, number of patients admitted per day and readmittances within 72 h following ED admission before and after changes were determined. Values are number of patients, mean ± SEM and mean differences with 95% CIs. Statistical significance was ascertained using Student’s two tailed t-test for unpaired values. Results Before and after ED changes crowding of 130% amounted to 123.8 h and 8.7 h in the latter. This is a difference of -115.3 ± 26.3 h with a 95% CI of -177.4 to -52.9, Δ% -93 (p = 0.03). There was the same amount of patients / day amounting to 135.2 and 132.3 patients / day Δ% = -3.5 ± 1.7 patients 95% CI -7.5 to 0.5 (p >0.08) There was no change in readmittances within 72 h before and after changes amounting to 8.9% versus 9.5%, Δ% = 0.5 ± 0.4% 95%CI -0.1 to 1.1 (p >0.09). Conclusion It appears feasible to abate crowding with unchanged patient admission and without an increase in readmittances by fast-track assessment and treatment of patients who are not in need of hospitalization.