Research Forum Abstracts

Study Objective: Determine the effect of waiting room time and ED length of
stay (LOS) on patient perceptions of team communication.
Methods: Prospective, cross-sectional sample from an academic, urban, 75,000
visit ED conducted Nov-Dec 2007. Patients completed the psychometrically
validated Communication Assessment Tool-Team (CAT-T) survey upon ED exit.
ED patients greater than 18 y/o, discharged or admitted were eligible. Exclusion
criteria: psychiatric patients, non-English speaking, or unstable. Primary outcome
variables: responses answered via a 5-point scale. Both univariate analysis and
multivariate regression were used. Results: 225 patients screened, 156 completed the
CAT-T. Mean age was 46, 57.4 % female. Average wait time was 38 minutes;
historical mean wait time was 45 minutes. Mean ED LOS was 206 minutes;
historical mean LOS was 232 minutes. No difference in % 5 scores (excellent)
ratings were noted comparing those who waited 45min vs. 45 min. In
multivariate analysis, controlling for age and sex, neither wait time nor LOS were
statistically significant predictors of patient perception of communication.
Conclusion: Neither increased ED wait times nor ED length of stay affect patient
perception of ED communication. Further study of the ED clinical environment is
necessary to identify potential systemic constraints on patient perceptions of medical
team communication.

226

The Effect of Implementation of an Observation

Unit on Emergency Department Wait Time to Initial
Physician Evaluation, Emergency Department
Length of Stay, Emergency Department Boarding
Times, and Percentage of Patients Who Left
Without Being Seen

Hedayati T, Desai S, Henderson SO/Los Angeles County/USC Keck School of

Medicine, Los Angeles, CA

Background: Emergency departments (ED) are dealing with increasing patient volumes in
the face of decreasing inpatient bed numbers, resulting in impaired ED flow, ED crowding,
and increased numbers of patients who leave without being seen by a physician (LWBS). In an
effort to improve ED throughput and, thereby, reduce the number of patients LWBS, many
EDs have established Observation Units (OU) to provide further evaluation and treatment to
patients who may not require inpatient admissions.
Study Objective: To determine the effect of instituting an ED OU for adult
patients on the patient wait time to initial ED physician evaluation (WTMD), ED
length of stay (EDLOS), ED patient boarding times (EDBT), and percentage of
patients LWBS in an academic, public, urban ED with an average annual volume of
141,000 adult patients.
Methods: The WTMD, EDLOS, patient BT, and percentage of patients
LWBS were analyzed in the eight-month period before and after the institution
of the Observation Unit (OU) for adult patients in a large, academic, public,
urban ED in September 2006. The data are presented as means with 95%
confidence intervals.
Results: The average WTMD prior to the opening of the OU was 4:33 (95% CI:
4:16, 4:49) which decreased to 4:15 (95% CI: 3:58,4:32) after the OU was
instituted, a change that was not statistically significant. The average EDLOS
decreased from 10:25 (95% CI: 9:45,11:04) to 9:15 (95% CI: 8:48,9:41). The
average EDBT decreased from 9:24 (95% CI: 7:44,11:03) to 7:15 (95% CI: 6:44,7:
46). The average percentage LWBS decreased from 12% (95% CI: 11.3,12.7) to
9.5% (95% CI: 8.1,10.9).
Conclusion: The institution of an OU in a large, academic, public, urban ED
significantly improved ED throughput as measured by decreased EDLOS. Average
EDBT also decreased substantially by over 2 hours and approached statistical
significance. These findings may be explained by the fact that patients sent to an EDmanaged OU avoid an inpatient admission and, thereby, eliminate the wait time for
an inpatient bed. This overall improved flow may have contributed to a statistically
significant decrease in the percentage of patients LWBS.

227

Emergency Department Bed Utilization Practices

Affect Efficiency Measures

Farley H, Lagerlund A, Lake A, Knox E, Reed III J/Christiana Care Health

System, Newark, DE

Study Objectives: Emergency department (ED) efficiency and the ability to

accommodate high patient volumes may be compromised when a significant
percentage of ED beds are unavailable. Bed closures due to inadequate staffing and

S112 Annals of Emergency Medicine

bed occupancy by boarding inpatients are two common reasons ED beds may be
unavailable for arriving patients. The purpose of this study was to determine if there
is a correlation between ED bed utilization (as measured by the percentage of beds
that are closed and the percentage of beds that are occupied by boarders) and ED
efficiency [as measured by average daily ED length of stay (LOS) and the number of
patients waiting in triage].
Methods: This was a retrospective observational study conducted over a 3-month
period in 2008 at a single ED with an annual volume of 100,000 patients. Average
ED LOS was calculated on a daily basis. The percentage of ED beds closed, the
percentage of ED beds occupied by boarding patients, and the number of patients
waiting in the triage area were collected from an electronic patient tracking system
automatically every 8 hours during the study period. These data were collected at a
single point in time during each typical nursing shift (day shift: 07:00-15:00, evening
shift: 15:00-23:00, night shift: 23:00-07:00). The percentage of beds occupied by
boarding patients was compared to the number of patients waiting in the triage area
for each time period. Day, evening, and night shift data were examined separately.
The average daily percentage of beds closed was compared to the average daily ED
LOS. Data were analyzed using Pearsons correlation and a P value of 0.05 was
considered significant.
Results: There was a statistically significant correlation between the
percentage of ED beds occupied by boarding patients and the number of patients
waiting in triage for each shift (day: r.33, p0.01; evening: r0.31, p0.01;
night: r0.45, p0.01). There was also a statistically significant correlation
between the average daily percentage of ED beds closed and the average daily ED
LOS (r0.30, p0.01).
Conclusion: The percentage of ED beds occupied by boarders was positively
correlated with the number of patients waiting in triage. The percentage of ED beds
closed was positively correlated with average ED LOS. In order to maximize
efficiency, efforts should be made to ensure that all ED beds remain available for
arriving patients.

228

Patient Expectation in a Freestanding Emergency

Department

Meyer-Reed EJ, Reeve KR, Wadman MC, Muelleman RL, Tran TP/University of
Nebraska Medical Center, Omaha, NE

Study Objectives: Freestanding emergency departments (FSED) have received

renewed interest in the US in response to changing trends in hospital outpatient
services and market incentives. There is, however, little academic health care
literature that specifically addresses the issue of patient expectation at a FSED.
We conducted one of the first comprehensive patient expectation surveys at a
suburban FSED.
Methods: Patient expectation surveys were administered by research assistants
(RA) using convenience sampling over 10 months. The 24/7 FSED is located in a
suburban area of a midsize city in the Midwest with a census of 14K/yr and a 4.71%
admission rate. Outpatient adults (19 yo) were eligible for enrollment. Patients
were excluded if they were 19 yo, hospitalized, had altered MS, or traumaactivated. The 43-question survey covered various areas of patient expectation,
including 1) Staff-related attributes (staff physician, resident, medical student, or PA/
MLP, physicians competence, bedside manner, communication skills), 2) Nursing
attributes, and 3) Throughput variables (registration, wait time, laboratory, imaging,
others). Patient response was recorded using a 5-point Likert scale (1-Not at all
important, 2-Somewhat unimportant, 3-No opinion, 4- Somewhat important, 5Extremely important). Data are reported as percentage or mean (95% CI);
proportional data are compared using 2.
Results: Of the 299 patients who were available for enrollment when the RA was
working, 62 met the exclusion criteria, leaving 237 patients eligible for enrollment.
Of these, 10 declined, 227 received surveys, and 162 surveys were returned for a
capture rate of 68.4% (61.2% - 75.5%). Demographics of the study patients are
tabulated in the table. 73 of the 162 patients expressed no preference for a particular
type of health care provider. Of the remaining 89 patients who expressed a
preference, 83 (93.3% [89.4% - 97.1%]) preferred to be seen by a staff physician, 4
(4.5% [1.3% - 7.7%]) a resident physician, 2 (2.2% [0 % - 4.5%]) medical student,
and none a PA/MLP. Expectations for various wait times were consistently short:
13.8 min (9.0 - 15.4) for wait in the waiting room, 23.4 min (22.7 - 25.9) for
laboratory testing, 31.3 min (29.7 - 33.0) for special imaging studies, and 64.0 min
(59.2 - 65.6) for the total visit. A higher proportion of patients rated seeing a
competent physician as 5-Extremely important compared to seeing a caring
physician [94.4% (90.9% - 98.0%) vs. 82.1% (76.2% - 88.0%), p 0.001)]. Other

Volume , . : October