{"pk":10758,"title":"Decreasing Emergency Department Walkout Rate and Boarding Hours by Improving Inpatient Length of Stay","subtitle":null,"abstract":"Introduction: Patient progress, the movement of patients through a hospital system from admission todischarge, is a foundational component of operational effectiveness in healthcare institutions. Optimalpatient progress is a key to delivering safe, high-quality and high-value clinical care. The Baystate PatientProgress Initiative (BPPI), a cross-disciplinary, multifaceted quality and process improvement project, waslaunched on March 1, 2014, with the primary goal of optimizing patient progress for adult patients.\nMethods: The BPPI was implemented at our system’s tertiary care, academic medical center, a highvolume,high-acuity hospital that serves as a regional referral center for western Massachusetts. TheBPPI was structured as a 24-month initiative with an oversight group that ensured collaborative goalalignment and communication of operational teams. It was organized to address critical aspects ofa patient’s progress through his hospital stay and to create additional inpatient capacity. The specificgoal of the BPPI was to decrease length of stay (LOS) on the inpatient adult Hospital Medicine serviceby optimizing an interdisciplinary plan of care and promoting earlier departure of discharged patients.Concurrently, we measured the effects on emergency department (ED) boarding hours per patient andwalkout rates.\nResults: The BPPI engaged over 300 employed clinicians and non-clinicians in the work. We createdincreased inpatient capacity by implementing daily interdisciplinary bedside rounds to proactively addresspatient progress; during the 24 months, this resulted in a sustained rate of discharge orders writtenbefore noon of more than 50% and a decrease in inpatient LOS of 0.30 days (coefficient: -0.014, 95%CI [-0.023, -0.005] P< 0.005). Despite the increase in ED patient volumes and severity of illness overthe same time period, ED boarding hours per patient decreased by approximately 2.1 hours (coefficient:-0.09; 95% CI [-0.15, -0.02] P = 0.007). Concurrently, ED walkout rates decreased by nearly 32% to amonthly mean of 0.4 patients (coefficient: 0.4; 95% CI [-0.7, -0.1] P= 0.01).\nConclusion: The BPPI realized significant gains in patient progress for adult patients by promotingearlier discharges before noon and decreasing overall inpatient LOS. Concurrently, ED boarding hoursper patient and walkout rates decreased.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"ED Crowding"},{"word":"Length of Stay"},{"word":"Walkouts. ED Boarding"}],"section":"Emergency Department Operations","is_remote":true,"remote_url":"https://escholarship.org/uc/item/9hh3r9vb","frozenauthors":[{"first_name":"Andrew","middle_name":"W.","last_name":"Artenstein","name_suffix":"","institution":"University of Massachusetts Medical School-Baystate, Department of Medicine, Division of Infectious Disease, Springfield, Massachusetts","department":"None"},{"first_name":"Niels","middle_name":"K.","last_name":"Rathlev","name_suffix":"","institution":"University of Massachusetts Medical School-Department of Emergency Medicine, Baystate, Springfield, Massachusetts","department":"None"},{"first_name":"Douglas","middle_name":"","last_name":"Neal","name_suffix":"","institution":"Baystate Health, Healthcare Quality and Process Improvement, Springfield, Massachusetts","department":"None"},{"first_name":"Vernette","middle_name":"","last_name":"Townsend","name_suffix":"","institution":"Baystate Health, Baystate Medical Center, Springfield, Massachusetts","department":"None"},{"first_name":"Michael","middle_name":"","last_name":"Vemula","name_suffix":"","institution":"Baystate Health, Department of Emergency Medicine, Springfield, Massachusetts","department":"None"},{"first_name":"Sheila","middle_name":"","last_name":"Goldlust","name_suffix":"","institution":"Baystate Health, Baystate Medical Center, Springfield, Massachusetts","department":"None"},{"first_name":"Joseph","middle_name":"","last_name":"Schmidt","name_suffix":"","institution":"University of Massachusetts Medical School-Department of Emergency Medicine, Baystate, Springfield, Massachusetts","department":"None"},{"first_name":"Paul","middle_name":"","last_name":"Visintainer","name_suffix":"","institution":"University of Massachusetts Medical School-Baystate, Office of Research, Springfield, Massachusetts","department":"None"}],"date_submitted":"2017-04-21T20:15:35Z","date_accepted":"2017-04-21T20:15:35Z","date_published":"2017-09-18T07:00:00Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/10758/galley/5866/download/"}]}