Resident-driven Quality Improvement Pre-post Intervention Targeting Reduction of Emergency Department Decision to Admit Time

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Rahim Kachra MD
Alison Walzak MD
Stacey Hall MD
William JA Connors MD
Katherine A Eso MS
Alejandra Boscan MD
Fiona Clement PhD
Jayne M Holroyd-Leduc MD


Long Emergency Department (ED) wait times represent a key point for quality improvement in many healthcare systems. A delayed ED disposition decision may lead to increased length of hospital stay, healthcare cost, and mortality. The objective of this resident-driven quality improvement (QI) intervention was to determine if a standardized resident admission protocol could reduce the ‘decision-to-admit’ (DTA) time of patients being assessed for admission to internal medicine (IM) at 3 tertiary care teaching hospitals.
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1. Highlights of 2010-2011 Inpatient Hospitalizations and Emergency Department Visits. Ottawa, Ontario: Canadian Institute for Health Information. 2012.
2. Shedding Light on Canadians’ Total Wait for Care: Report Card on Wait Times in Canada. Wait Time Alliance for Timely Access to Health Care. 2012.
3. Wait Times in Canada - A Summary. Ottawa, Ontario: Canadian Institute for Health Information. 2012.
4. Canadian Association of Emergency Physicians. CAEP Position Statement: Joint position statement on emergency department overcrowding. CJEM 2001;3(2):82-88.
5. Richardson DB. Increase in patient mortality at 10 days associated with emergency department overcrowding. Med J Aust 2006;184(5):213-216.
6. Huang Q, Thind A, Dreyer JF, Zaric GS. The impact of delays to admission from the emergency department on inpatient outcomes. BMC Emerg Med 2010;10:16 doi: 10.1186/1471-227X-10-16.
7. Soong C, High S, Morgan MW, Ovens H. A novel approach to improving emergency department consultant response times. BMJ Qual Saf 2013;22:299-305.
8. Horng S, Pezzella L, Tibbles CD, et al. Prospective evaluation of daily performance metrics to reduce emergency department length of stay for surgical consults. J Emerg Med 2013;44(2):519-525.
9. Rathlev NK, Chessare J, Olshaker J, et al. Time series analysis of variables associated with daily mean emergency department length of stay. Ann Emerg Med 2007;49(3):265-271.
10. Foley M, Kifaieh N, Mallon WK. Financial impact of emergency department crowding. West J Emerg Med 2011 May;12(2):192-197.
11. Nelson EC, Batalden PB, Lazar JS. Practice-based Learning and Improvement: A Clinical Improvement Action Guide. Joint Commission on Accreditation of Healthcare Organizations. 2007.