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Saturday, March 20, 2010
Grand Hall (Hyatt Regency Atlanta)
Background: Increasing demands placed upon emergency departments (ED) have led to overcrowding and long wait times which can negatively impact on patient safety and hospital operation. Although patient specific factors (complexity and acuity) as well as characteristics of the healthcare facility (bed available, staffing, access to diagnostic tests and discharge procedures) have been associated with extended length of stay in the ED, the impact of Infection Prevention and Control (IP&C) additional precautions necessary to prevent transmission of infectious diseases has not been previously explored.
Objective: To describe the utilization of IP&C additional precautions for admitted patients in the ED of a tertiary care teaching hospital and to determine their impact on bed wait times.
Methods: All patient admissions to Sunnybrook Health Sciences Centre, a 1100 bed tertiary care teaching hospital in Toronto, Canada, that occurred via the ED from April 2007 to March 2008 were obtained from the Emergency Department Information System (EDIS) and cross referenced with IP&C daily surveillance reports for the same period. Patients requiring additional precautions were identified as those cared for in airborne, contact, and/or droplet precautions at the time of transfer to an inpatient unit or at any time during their stay in the ED. The primary outcome calculated for each patient admission was bed wait time, defined as the time spent in the ED from the physician’s decision to admit to the time the patient left the ED for transfer to an inpatient bed.
Results: 11% of patient admissions via the ED required additional precautions. Admitted patients requiring additional precautions were older (72 versus 63 years<0.001), more likely to be admitted to a medical bed (81% versus 50% P<0.001) and had a higher acuity as indicated by a triage score of 1 (15 versus 2% P<0.001). The mean bed wait time for all patients admitted via the ED in 2007-08 was 5.05 hours (±7.05 hrs) with patients requiring additional precautions waiting longer from the decision to admit until transfer to an inpatient bed (10.1 versus 4.43 hrs, mean difference = 5.65 hrs, 95%CI 4.93-6.38 hrs;P<0.001). Bed wait times for patients cared for in additional precautions were consistently higher after stratification by patient age and acuity, and the type of admitting bed. No significant difference was reported for the mean bed wait time by type of additional precautions (airborne 11 hrs, contact 9.82 hrs, and droplet 10.35 hrs).
Conclusions: Admitted patients in the ED requiring additional precautions spend significantly longer waiting for transfer to an inpatient bed after the physician’s decision to admit. This increase in bed wait times, combined with the potential for transmission of infectious diseases, may heighten the risk to patients and staff in the ED if appropriate resources for their management are not in place.
Objective: To describe the utilization of IP&C additional precautions for admitted patients in the ED of a tertiary care teaching hospital and to determine their impact on bed wait times.
Methods: All patient admissions to Sunnybrook Health Sciences Centre, a 1100 bed tertiary care teaching hospital in Toronto, Canada, that occurred via the ED from April 2007 to March 2008 were obtained from the Emergency Department Information System (EDIS) and cross referenced with IP&C daily surveillance reports for the same period. Patients requiring additional precautions were identified as those cared for in airborne, contact, and/or droplet precautions at the time of transfer to an inpatient unit or at any time during their stay in the ED. The primary outcome calculated for each patient admission was bed wait time, defined as the time spent in the ED from the physician’s decision to admit to the time the patient left the ED for transfer to an inpatient bed.
Results: 11% of patient admissions via the ED required additional precautions. Admitted patients requiring additional precautions were older (72 versus 63 years<0.001), more likely to be admitted to a medical bed (81% versus 50% P<0.001) and had a higher acuity as indicated by a triage score of 1 (15 versus 2% P<0.001). The mean bed wait time for all patients admitted via the ED in 2007-08 was 5.05 hours (±7.05 hrs) with patients requiring additional precautions waiting longer from the decision to admit until transfer to an inpatient bed (10.1 versus 4.43 hrs, mean difference = 5.65 hrs, 95%CI 4.93-6.38 hrs;P<0.001). Bed wait times for patients cared for in additional precautions were consistently higher after stratification by patient age and acuity, and the type of admitting bed. No significant difference was reported for the mean bed wait time by type of additional precautions (airborne 11 hrs, contact 9.82 hrs, and droplet 10.35 hrs).
Conclusions: Admitted patients in the ED requiring additional precautions spend significantly longer waiting for transfer to an inpatient bed after the physician’s decision to admit. This increase in bed wait times, combined with the potential for transmission of infectious diseases, may heighten the risk to patients and staff in the ED if appropriate resources for their management are not in place.