By Stacey Kusterbeck
Some adverse outcomes in ED patients could be prevented if actions had happened faster — if someone had been moved to the cardiac catheterization lab faster, secured an inpatient bed sooner, or undergone stroke treatment swiftly. If the patient or families sue for malpractice, plaintiff attorneys will scrutinize those time frames.
“For STEMI, shock, and stroke in particular, those are patients where seconds matter,” says Sanjay Pattani, MD, MHSA, FACEP, associate chief medical officer of AdventHealth Mission Control.
Staff in this Florida control center use real-time data to forecast capacity in 18 EDs in the health system and track every patient. If there is congestion in the ED or in the inpatient unit, patients could be transported to locations where they can receive what they need immediately.
“We are balancing resources within our system to match the level of care a patient needs with a certain location so we don’t have one ED at 90% capacity and another ED at 72% capacity,” explains Pattani, who offers some examples:
• Some ED patients present to a community hospital, but the intervention or higher-level care they need is unavailable. “We use Mission Control to move people within the system to provide better care,” Pattani reports.
If one patient arrives with an acute myocardial infarction (MI), Mission Control instantly coordinates the cath lab team, an interventional cardiologist, and EMS transport to move the patient to his or her destination. If a second acute MI patient arrives shortly afterward, Mission Control coordinates an alternative destination, and activates the same process quickly.
• Some ED patients come out of surgery and need another procedure, but there is no capacity. Say a stroke patient who undergoes interventional radiology needs to be admitted to a neurosurgery ICU, but there are no available beds. In that scenario, the patient could be transported to another hospital with an available ICU bed.
• Some patients are boarded in an ED while waiting for an inpatient bed at a hospital that offers higher levels of subspecialty care, but the patient does not require that high-level care. To match the right bed with the right patient at the right time, Mission Control identifies an alternative hospital that matches the patient’s acuity and resource needs.
That patient moves out of the hallway and into an inpatient bed sooner, freeing up a bed for a patient who needs high-level care. It also moves the patient out of the already-crowded ED, which cuts boarding times.
• Some ED patients who are boarded while waiting for an inpatient bed can move to a bed immediately at another location. Staffing shortages can bottleneck the movement of patients from the ED to the inpatient side.
“If there is overcapacity on the inpatient side, there is congestion in the ED,” Pattani says.
If the waiting room is full, some of those people will decide to leave without being seen (LWBS). With Mission Control, if an ED is boarding patients, some might be transferred elsewhere after the facility hits a certain threshold.
“The more you decrease delays in care, the more you decrease length of stay, and the less time you spend in the hospital. I don’t know of anyone who wouldn’t support that goal,” Pattani offers.
On average, LWBS rates decreased to below 2%, and the average times for admitted ED patients to be placed in an inpatient bed declined by 23 minutes. ED patients are receiving the care they need faster, and likely are not concerned about all that happens behind the scenes, just grateful for the speedy transitions.
Some adverse outcomes in ED patients could be prevented if actions had happened faster — if someone had been moved to the cardiac catheterization lab faster, secured an inpatient bed sooner, or undergone stroke treatment swiftly. If the patient or families sue for malpractice, plaintiff attorneys will scrutinize those time frames.
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