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ED/hospitalist plan improves throughput: collaboration also reduces diversions.
A new plan for admitting patients from the emergency department (ED) at Johns Hopkins Bayview Medical Center in Baltimore jointly developed by an ED physician and a hospitalist, decreased ED throughput for admitted patients 98 minutes (from 458 minutes to 360 minutes) from the same period a year earlier, despite an 8.8% increase in the ED census. The proportion of hours that the ED was on ambulance diversion because of ED crowding decreased 6 percentage points, or 182 fewer hours. The proportion of hours that the ED was on red alert (ambulance diversion due to lack of ICU beds in the hospital) decreased 27 percentage points, or 786 fewer hours.
"Before this plan, admissions were largely handled from house staff to house staff, which we called 'service ping pong,'" recalls Edward Bessman, MD, FAAEM, FACEP, who was then an ED physician and is now chairman of emergency medicine. "There was a lot of back and forth, where physicians agreed the patients needed to be admitted, but not necessarily to their service."
That problem has been eliminated, because now a hospitalist, in consultation with the treating ED physician, makes the final decisions for admitting ED patients to the cardiac ICU; the medical ICU; and the cardiology, pulmonary, and general medicine units. That same position, filled on a rotating basis by all hospitalists, is responsible for 24/7 bed management. ICU admissions are transferred no longer than 90 minutes after the assignment decision is made, while patients admitted to ...
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