A Rapid Medical Screening Process Improves Emergency Department Patient Flow During Surge Associated With Novel H1N1 Influenza Virus - 12/07/13
, Kathleen M. Brown, MD a, c, David J. Mathison, MD a, c, Jennifer Kingsnorth, MSN, RN c, Sephora Morrison, MD a, Mohsen Saidinejad, MD a, c, Jeff Greenberg, MD b, c, Michael Knapp, MSN, RN c, James M. Chamberlain, MD a, c
Address for correspondence: Daniel B. Fagbuyi, MD, Division of Emergency Medicine, Children's National Medical Center, 111 Michigan Ave, NW, Washington, DC 20010; 202-476-2080, fax 202-476-3573Résumé |
Study objective |
We compare emergency department (ED) patient flow during the fall 2009 novel H1N1-associated surge in patient volumes at an urban, tertiary care, pediatric medical center to that in the previous winter virus season.
Methods |
A rapid medical screening process was instituted to manage the surge in patient census. The process included the use of a new, separate clinical area converted from office space adjacent to the ED, the introduction of a new preprinted checklist for rapid documentation of medical history and physical examination of patients with influenza-like illness, the use of classroom-style parent discharge education, and the use of preprinted discharge prescription and instructions. We compared patient flow parameters, including waiting time, length of stay, and elopement rates, and returns within 48 hours and 7 days for a comparable period in winter 2008 to 2009.
Results |
During the first 30 days of the novel H1N1-associated surge in patient volumes (October 12 to November 10, 2009), overall ED daily volumes increased by a mean of 113 (51.8%) compared with baseline (daily increase range 49 to 118 patients). Of the 10,013 patients treated during this period, 4,287 (42.8%) had complaints consistent with influenza-like illness and 1,767 (17.6%) were treated with the rapid screening process. The mean wait time decreased from 92.9 to 81.2 minutes (difference 11.7 minutes; 95% confidence interval [CI] 10.2 to 13.2 minutes). Overall mean ED length of stay decreased from 241 to 212.3 minutes (difference 28.7 minutes; 95% CI 25.8 to 31.6 minutes). Rates of elopement were unchanged, and elopement rates as a function of daily patient volumes showed improved responsiveness to high volumes. Rates of return were unchanged within 48 hours (3.0% in 2009 versus 2.9% in 2008; odds ratio 1.03 [0.91 to 1.18]) and within 7 days (6.2% in 2009 versus 5.7% in 2008; odds ratio 1.09 [0.99 to 1.20]). The use of the rapid screening process required a mean of 23.5 (95% CI 16.4 to 30.6) additional hours per day of physician staffing and a mean of 26.3 (95% CI 18.5 to 34.1) additional hours of nursing staffing.
Conclusion |
The implementation of a rapid screening process during the fall 2009 H1N1-associated surge in patient volumes was associated with improved patient flow without affecting rates of return to the ED within 48 hours or 7 days. This was accomplished with only a modest increase in staffing.
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| Author contributions: DBF and JMC conceived and supervised the study. DBF, JK, and JMC performed the background research for the study. DBF, KMB, JK, and JMC designed the study. DBF, DJM, MS, JG, and JMC wrote the article. DBF, DJM, MS, JG, and JMC edited the article. SM, MS, and JG critiqued the study. DBF managed the data, corresponded between coauthors, and arranged meetings. KMB and JK were responsible for recruitment. KMB, JK, and MK were responsible for data collection and analysis. KMB and JMC provided guidance and were involved in critique of the article. JK provided figures for this study. JK, MK, SM, and MS provided input on what worked well and what did not. SM edited the shared data. DJM performed the literature search, obtained and populated the references, and reviewed articles. All authors were involved in and contributed to the revisions of the article and take responsibility for the paper as a whole. |
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Vol 57 - N° 1
P. 52-59 - janvier 2011 Retour au numéro
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