CORRESPONDENCE
Regarding: Effects of Emergency Department Expansion on Emergency Department Patient Flow To the Editor: We read with great interest the recent article “Effects of Emergency Department Expansion on Emergency Department Patient Flow” by Mumma et al.1 Similar to their emergency department (ED) at UC Davis, our ED, located just 20 miles away, also underwent an expansion in 2009 from 35 beds to 61 beds. We studied the effect of this expansion on admit wait times as well as other ED patient flow data.2 Using multivariable linear regression models and analysis, we found a significant reduction in admit wait time, defined as the percentage of patients who left the ED within 60 minutes of a request for an inpatient bed. However, similar to the current study, we found no significant change in boarding time per admission, lengths of stay (LOS), patient satisfaction, patients leaving without being seen (LWBS), or ambulance diversion hours. Around the same time, at another local ED, we studied the effect of a leadership-based program to reduce admit wait times.3 We found significant improvements in admit wait times, boarding time per admission, LOS, patient satisfaction, LWBS, and ambulance diversion hours. Interestingly, during the period of study, we actually reduced physical bed capacity at this ED from 45 beds down to 36 beds. We agree with the authors that ED expansion alone is not an adequate solution for ED crowding. Our experience would indicate that process improvement and active leadership support to directly oversee patient
1300 1300
ISSN 1069-6563 1300 PII ISSN 1069-6563583
flow might be significantly more effective in reducing ED crowding. doi: 10.1111/acem.12499
Pankaj B. Patel, MD ([email protected]) David R. Vinson, MD Department of Emergency Medicine The Permanente Medical Group Kaiser Permanente Medical Centers Sacramento and Roseville, CA Supervising Editor: Jeffrey Kline, MD.
References 1. Mumma BE, McCue JY, Li C, Holmes JF. Effects of emergency department expansion on emergency department patient flow. Acad Emerg Med 2014;21:504–9. 2. Patel PB, Vinson DR, Combs MA. Reducing emergency department admission wait times: two successful approaches. Ann Emerg Med 2013;62(4S):S12. 3. Patel PB, Combs MA, Vinson DR. Reduction of admit wait times: the effect of a leadership-based program. Acad Emerg Med 2014;21:266–73.
© 2014 by the Society for Academic Emergency Medicine doi: 10.1111/acem.12499
Regarding: Effects of Emergency Department Expansion on Emergency Department Patient Flow To the Editor: We read with great interest the recent article “Effects of Emergency Department Expansion on Emergency Department Patient Flow” by Mumma et al.1 Similar to their emergency department (ED) at UC Davis, our ED, located just 20 miles away, also underwent an expansion in 2009 from 35 beds to 61 beds. We studied the effect of this expansion on admit wait times as well as other ED patient flow data.2 Using multivariable linear regression models and analysis, we found a significant reduction in admit wait time, defined as the percentage of patients who left the ED within 60 minutes of a request for an inpatient bed. However, similar to the current study, we found no significant change in boarding time per admission, lengths of stay (LOS), patient satisfaction, patients leaving without being seen (LWBS), or ambulance diversion hours. Around the same time, at another local ED, we studied the effect of a leadership-based program to reduce admit wait times.3 We found significant improvements in admit wait times, boarding time per admission, LOS, patient satisfaction, LWBS, and ambulance diversion hours. Interestingly, during the period of study, we actually reduced physical bed capacity at this ED from 45 beds down to 36 beds. We agree with the authors that ED expansion alone is not an adequate solution for ED crowding. Our experience would indicate that process improvement and active leadership support to directly oversee patient
1300 1300
ISSN 1069-6563 1300 PII ISSN 1069-6563583
flow might be significantly more effective in reducing ED crowding. doi: 10.1111/acem.12499
Pankaj B. Patel, MD ([email protected]) David R. Vinson, MD Department of Emergency Medicine The Permanente Medical Group Kaiser Permanente Medical Centers Sacramento and Roseville, CA Supervising Editor: Jeffrey Kline, MD.
References 1. Mumma BE, McCue JY, Li C, Holmes JF. Effects of emergency department expansion on emergency department patient flow. Acad Emerg Med 2014;21:504–9. 2. Patel PB, Vinson DR, Combs MA. Reducing emergency department admission wait times: two successful approaches. Ann Emerg Med 2013;62(4S):S12. 3. Patel PB, Combs MA, Vinson DR. Reduction of admit wait times: the effect of a leadership-based program. Acad Emerg Med 2014;21:266–73.
© 2014 by the Society for Academic Emergency Medicine doi: 10.1111/acem.12499
