Assessing time to treatment and patient inflow in a Danish emergency department: a cohort study using data from electronic emergency screen boards

BMC Research Notes

Karin Biering¹  Poul Petersen²  Noel Pérez²  Rasmus F Nielsen³ 

[1] Department of Occupational Medicine, Regional Hospital West Jutland, Herning, Denmark;Department of Emergency Medicine, Regional Hospital West Jutland, Herning, Denmark;Akutmodtagelsen, Gl. Landevej 61, 7400 Herning, Denmark

关键词: Electronic overview screen boards;    Inflow;    Time to treatment;    Triage;    Quality assessment;    Emergency department;   

Others  :  1127375
DOI  :  10.1186/1756-0500-7-690

 received in 2014-09-25, accepted in 2014-10-01,  发布年份 2014

【 摘 要 】

Background

The purpose of this study was to assess and describe the patient inflow during a 1-month period in a Danish emergency department and to evaluate if the intended times to treatment (TTT) related to category of triage were met.

Methods

Data from electronic emergency screen boards were extracted from the 1st to the 30th of April 2013. 2000 patients were enrolled of which 1011 were eligible for inclusion in the study of TTT. Patient inflow was described according to hours of the day and days of the week. Patients were divided into groups of triage and TTT was assessed in the different groups. Adjusted odds ratios of not being seen on time were calculated between triage groups and time of the day/week.

Results

The pattern of inflow differed between weekdays and weekends. On weekdays it peaked around midday and on weekends it peaked during the late afternoon/evening. The distributions of the different triage categories between days were similar. Monday had the most patient contacts while Saturday showed the least. Category II (orange) patients were the most prone to exceed the intended TTT. The risk of not being seen on time when compared to daytime, was on evenings OR 2.3 [1.1;4.9] and on nights OR 2.0 [1.2;3.9]. On weekends the odds ratio was OR 1.9 [0.8;4.7] compared to weekdays.

Conclusion

The results demonstrated varying patterns of patient inflow between weekdays and weekends. There was a significantly increased risk of being attended late when arriving on evenings and nights. Likewise higher acuity was associated with exceeded TTT.

【 授权许可】

   
2014 Nielsen et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

Figure 4.

【 参考文献 】

• [1]Danish Health and Medicines Authority: Strengthened Alert - Organizatorial Basis for the Regional Health Service. 2007. [http://sundhedsstyrelsen.dk/publ/Publ2007/PLAN/Akutberedskab/StyrketAkutberedskab.pdf webcite]
• [2]Harvard Medical Faculty Physicians: Report on the Emergency Care System in Central Denmark Region. 2008. [http://www.regionmidtjylland.dk/files/Aktuelt/Metteb/Diverse%20rapporter%20og%20dokumenter/Report%20on%20the%20Emergency%20Care%20System%20in%20Region%20Midtjylland.pdf webcite]
• [3]Regional Hospital Horsens, Denmark, Department of Acute Medicine: IT-support as a Means to Higher Efficacy and Quality in Medical Treatment. 2011. [http://www.digst.dk/~/media/Afsluttede%20projekter/Interaktive%20storsk%C3%A6rme%20og%20smartphones%20giver%20overblik%20i%20akutmodtagelsen/Rapport_It_st%C3%B8tte_til_den_f%C3%A6lles_akut_modtage_enhed.ashx webcite]
• [4]Danish Regions: Overview of the Work on Joined Emergency Departments in the Regions. 2012. [http://www.regioner.dk/~/media/Mediebibliotek_2011/SUNDHED/Akut%20og%20pr%C3%A6hospital/Overblik%20over%20regionernes%20arbejde%20med%20f%C3%A6lles%20akutmodtagelser.ashx webcite]
• [5]Lindberg SO, LerchelaCour J, Folkestad L, Hallas P, Brabrand M: The use of triage in Danish emergency departments. Dan Med Bull 2011, 58(10):A4301.
• [6]Regional Hospital West Jutland: Triage Manual. [http://e-dok.rm.dk/edok/Admin/GUI.nsf/Desktop.html?open&openlink=http://edok.rm.dk/edok/enduser/portal.nsf/Main.html?open&unid=X7BA3239C8A15E38BC125799100310EA1&dbpath=/edok/editor/HOVEAK.nsf/&windowwidth=1100&windowheight=600&windowtitle=S%F8g webcite]
• [7]Widgren BR, Jourak M: Medical emergency triage and treatment system (METTS): a new protocol in primary triage and secondary priority decision in emergency medicine. J Emerg Med 2011, 40(6):623-628.
• [8]Nissen L, Kirkegaard H, Perez N, Horlyk U, Larsen LP: Inter-rater agreement of the triage system RETTS-HEV. Eur J Emerg Med 2013. doi:10.1097/MEJ.0b013e32836397d9
• [9]Perez N, Nissen L, Nielsen RF, Petersen P, Biering K: The predictive validity of RETTS-HEV as an acuity triage tool in the emergency department of a Danish regional hospital. Eur J Emerg Med 2014. (e-pub ahead of print
• [10]Centre for Patient Experience and Evaluation, The Capital Region of Denmark: Report on Emergency Department Patients Waiting Time. 2011. [http://www.patientoplevelser.dk/sites/patientoplevelser.dk/files/dokumenter/artikel/ventetid_2011.pdf webcite]
• [11]Danish Ministry of Health, Board of Acute Medicine: Waiting Times in Emergency Departments. 2012. [http://www.sum.dk/~/media/Filer%20-%20Publikationer_i_pdf/2012/Ventetider-akut/Akutudvalget-afrapportering-om-ventetider-i-akutmodtagelser.ashx webcite]
• [12]Gordon BD, Flottemesch TJ, Asplin BR: Accuracy of staff-initiated emergency department tracking system timestamps in identifying actual event times. Ann Emerg Med 2008, 52(5):504-511.
• [13]Guttmann A, Schull MJ, Vermeulen MJ, Stukel TA: Association between waiting times and short-term mortality and hospital admission after departure from emergency department: population based cohort study from Ontario, Canada. BMJ 2011, 342:d2983. doi:10.1136/bmj.d2983
• [14]Arkun A, Briggs WM, Patel S, Datillo PA, Bove J, Birkhahn RH: Emergency department crowding: factors influencing flow. West J Emerg Med 2010, 11(1):10-15.
• [15]Pate DC, Puffe M: Special report: quality of care survey: improving patient flow. Physician Exec 2007, 33(3):32-36.
• [16]Cetrea EmergencyTM. [http://cetrea.com/index.php/da/products-2/ccl4-department-dk/ccl4-emergency webcite]
• [17]Ekelund U, Kurland L, Eklund F, Torkki P, Letterstål A, Lindmarker P, Castrén M: Patient throughput times and inflow patterns in Swedish emergency departments: a basis for ANSWER, A National SWedish Emergency Registry. Scand J Trauma Resuscitation Emerg Med 2011, 19(1):37. BioMed Central Full Text
• [18]National Health Service, The Health and Social Care Information Centre: Accident and Emergency Attendances in England 2007–08. 2009. [http://www.hscic.gov.uk/catalogue/PUB02535/acci-emer-atte-eng-2007-2008-rep.pdf webcite]
• [19]National Health Service, The Health and Social Care Information Centre: Accident and Emergency Attendances in England (Experimental Statistics) 2009–10. 2011. [http://www.hscic.gov.uk/catalogue/PUB02563/acci-emer-atte-eng-2009-2010-rep.pdf webcite]
• [20]Friesen MR, Strome T, Mukhi S, McLoed R: Load balancing at emergency departments using ‘crowdinforming’. Online J Public Health Inform 2011., 3(2) 10.5210/ojphi.v3i2.3520
• [21]McCarthy ML, Zeger SL, Ding R, Levin SR, Desmond JS, Lee J, Aronsky D: Crowding delays treatment and lengthens emergency department length of stay, even among high-acuity patients. Ann Emerg Med 2009, 54(4):492-503.