EMERGENCY MEDICINE Clinical Trial
Official title:
Characterizing ER Activities for Failure Prevention
Analysis of electronic files of patients presenting to the emergency department to improve current practice
Overcrowding in the emergency department (ED) is a pressing healthcare issue globally and has
been shown to negatively affect the quality of treatment, clinical outcomes and patient
satisfaction.
In recent years, an increasing number of studies have tried to implement changes in the ED to
increase efficiency and thereby reduce the length of stay (LOS). Examples to these efforts
include physician triage, expanding the nursing scope of practice and patient-flow design
(e.g., creating fast track units) in the ED. Importantly, not all intuitive changes in the ED
resulted in the reduction of LOS Therefore, implementing changes in the ED must be done with
caution and preceded with a cost-benefit analysis of the effects of the intervention using
available retrospective data.
This research was conducted in the ED of Sheba Medical Center (SMC), a tertiary
government-owned hospital in Israel with 1400 beds. This study is a retrospective medical
record review of patients admitted to the adult primary SMC ED. The study sample comprises
all the walk-in patients that visited the ED between January 2013 and December 2017. The data
here does not include other EDs located elsewhere in SMC, (e.g., pediatric ED, gynecology ED,
ophthalmology ED, and psychiatric ED). All admissions files in SMC ED are recorded in a
computerized system with negligible exceptions (such as power outage and connection or server
maintenance). The time and date of every change in the electronic files are also recorded in
the system. Therefore, it is possible to track the waiting times as well as the full content
of the admission file.
The aim of this study is to identify and analyze potential modifications in current ED
practice which may improve outcomes such as LOS, missed diagnosis, leaving without being
seen, patient satisfaction, etc.
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