Academic Hospitalists

​Hi Academic Hospitalist interest group,

I have been tasked with joining a QI project to reduce ED LOS.  I was hoping to get some insights from my wonderful SGIM colleagues. I also posted on the QI board; sorry if anyone got this twice!  

We are trying to reduce our ED length of stay and move patients to the floor quicker.  In our current process, the ED calls the team and the resident evaluates the patient in the ED followed by admission orders. The time to evaluation is variable but can take up to an hour which causes delays in moving patients. In an effort to balance resident education and patient safety with ED flow, we thought of identifying  "low risk" admissions. These "low risk" admission would move to the floor with an admit order from the ED attending and after discussion with the medical team. The medical team would then evaluate the patient on the medical floor.

 

Do any of your ED physicians write the admit order and the patient is evaluated on the floor and could share your experience? Does anyone have a policy? 

Thank you!!
Jess

 

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Jessica Logan, MD
Hospitalist, Washington DC VA Medical Center
Assistant Professor of Medicine, George Washington University
Clinical Assistant Professor of Medicine, Uniformed Services University
GW Medicine Clerkship Co-Director
Office 202-745-8000 x58248
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At Westchester Medical Center, the ED doctor/PA talks to the hospitalist attending on call for every admission. If the patient is deemed stable, the ED gives a "rapid admit order" instruction to the admitting resident (we have a dedicated resident in the ED for admissions about 20 hours a day), who then puts in the admit order immediately. This reduced the time from "decision to admit" to "admit order placed" from about 130 minutes to about 75 minutes. The goal was 30 minutes (although I personally thought that was not achievable).

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Randy Goldberg, MD MPH FACP
Westchester Medical Center
Valhalla, NY
randy.goldberg@wmchealth.org
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Original Message:
Sent: 02-22-2018 10:16
From: Jessica Logan
Subject: Reducing ED LOS

​Hi Academic Hospitalist interest group,

I have been tasked with joining a QI project to reduce ED LOS.  I was hoping to get some insights from my wonderful SGIM colleagues. I also posted on the QI board; sorry if anyone got this twice!

We are trying to reduce our ED length of stay and move patients to the floor quicker.  In our current process, the ED calls the team and the resident evaluates the patient in the ED followed by admission orders. The time to evaluation is variable but can take up to an hour which causes delays in moving patients. In an effort to balance resident education and patient safety with ED flow, we thought of identifying  "low risk" admissions. These "low risk" admission would move to the floor with an admit order from the ED attending and after discussion with the medical team. The medical team would then evaluate the patient on the medical floor.

 

Do any of your ED physicians write the admit order and the patient is evaluated on the floor and could share your experience? Does anyone have a policy?

Thank you!!
Jess

 

------------------------------
Jessica Logan, MD
Hospitalist, Washington DC VA Medical Center
Assistant Professor of Medicine, George Washington University
Clinical Assistant Professor of Medicine, Uniformed Services University
GW Medicine Clerkship Co-Director
Office 202-745-8000 x58248
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