Reducing Emergency Department Length of Stay by System Change
Emergency departments (ED) are exceeding the Centers for Medicare and Medicaid Services and The Joint Commission's recommended 4-hour door-to-admission and 2-hour door-to-discharge for patients. The purpose of this project was to look for factors that decrease door-to-admission and door-to-discharge times and offer recommendations to the Patient Flow Committee (PFC) at the health care facility that may reduce overcrowding, diversion, and patient boarding. The 7-step Iowa model of evidence-based practice (EBP) was used to concentrate on problem-focused triggers that initiate the need for change. The project focused on decreasing door-to-admission and door-to discharge times: by opening an observation unit run by the ED to decrease door-to-admission and door-to-discharge times, increasing point-of-care testing (POCT) within the ED to decrease patients' door-to-admission and door-to-discharge times, and placing a provider in triage to decrease the number of non-urgent patients seen in the ED. A systematic literature review was conducted to gather evidence-based practices other organizations have implemented to decrease the ED patients' length of stay. Article inclusion was based on those strategies that would best fit the milieu of the ED and would be sustainable. Four themes including guidelines, algorithms, expanded services, and modified processes were identified through comprehensive analysis of pertinent literature. A presentation to the 20 member multidisciplinary PFC team presented changes to the current system that may meet goals of reducing overcrowding, diversion, and patient boarding. Since door-to-admission and door-to-discharge times are reported quarterly to the PFC, members will be able to see the impact of the changes and on decreased times for ED patients.