Study links delays to bed availability
A five-year time study conducted at Olive View-University of California at Los Angeles (UCLA) Medical Center in Sylmar demonstrates a connection between bed availability and patient flow.
"When there are patients boarded in the ED awaiting admission, we become inefficient," says David Talan, MD, FACEP, chairman of the department of emergency medicine at Olive View-UCLA Medical Center, professor of medicine at the UCLA school of medicine, and one of the study’s researchers. "This causes delays in bringing patients in from the waiting room and caring for those others who we are initially evaluating in the ED," he says.
The study showed that if a bed was available upstairs in an inpatient service or in the ED itself, the time from when the patient arrived in the ED to evaluation was much shorter and the number of patients who left without being seen (LWBS) was decreased.1
"We used a graph to show the direct correlation with times seen by the physician, to the number of patients leaving," says Vena Ricketts, MD, FACEP, assistant chief of the department of emergency medicine at Olive View, professor of medicine at the medical school, and one of the study’s investigators. (See graph, p. 135, bottom.)
The researchers tracked how long it took to get a patient from the waiting room into the ED, depending upon if a bed was available in the ED. If a bed was available, the time from completion of registration to getting the patient into the ED was a median of 29 minutes. If there was no bed available, that delay increased to 65 minutes.
"That is very important information to have because it helps you plan how many beds need to be available in your ED," says Demetrios Kyriacou, MD, PhD, assistant professor of medicine at the medical school, director of trauma care in the ED at Olive View, and the study’s principal investigator.
Inpatient bed availability also was examined. "We looked at the delay from the time we decided a patient needs to be admitted to the time they actually leave the ED and go upstairs," says Kyriacou. "If there was a bed available, it took a median of 95 minutes to get the patient upstairs. If there was no bed available, then it took 220 minutes."
There are fewer nursing staff and less space available for the ED patients while they wait for a bed to become available.
"This can take many hours," says Pamela Dyne, MD, FACEP, assistant professor of medicine at the medical school and director of the emergency residency program at Olive View. "It is probably the major factor affecting flow of patients in our ED and many others."
Reference
1. Kyriacou DN, Ricketts V, Dyne PL, et al. A 5-year time study analysis of emergency department patient care efficiency. Ann Emerg Med 1999; 34:326-335.
• Pamela L. Dyne, MD, Demetrios Kyriacou, MD, David Talan, MD, FACEP, Vena Ricketts, MD, Olive View-UCLA Medical Center, Department of Emergency Medicine, North Annex, 14445 Olive View Drive, Sylmar, CA 91342. Telephone: (818) 364-3107. Fax: (818) 364-3268.
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