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Assessment of consultation impact on emergency department operations through novel metrics of responsiveness and decision-making efficiency

Published online by Cambridge University Press:  04 March 2015

Patricia A. Lee ,
Brian H. Rowe ,
Grant Innes ,
Eric Grafstein ,
Renee Vilneff ,
Dongmei Wang ,
Susan van Rheenen  and
Eddy Lang
Patricia A. Lee
Affiliation:
Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB
Brian H. Rowe
Affiliation:
Department of Emergency Medicine and School of Public Health, University of Alberta, Edmonton, AB
Grant Innes
Affiliation:
Department of Emergency Medicine, University of Calgary, Calgary, AB
Eric Grafstein
Affiliation:
Department of Emergency Medicine, University of British Columbia, Vancouver, BC
Renee Vilneff
Affiliation:
Department of Emergency Medicine, University of Calgary, Calgary, AB
Dongmei Wang
Affiliation:
Department of Emergency Medicine, University of Calgary, Calgary, AB
Susan van Rheenen
Affiliation:
Department of Emergency Medicine, University of Calgary, Calgary, AB
Eddy Lang*
Affiliation:
Department of Emergency Medicine, University of Calgary, Calgary, AB
*
Department of Emergency Medicine, University of Calgary, Calgary, AB T2N 2T9; eddy.lang@albertahealthservices

Abstract

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Objectives:

Requests for specialty consultation are common in emergency departments (EDs) and often contribute to delays in throughput. Our objectives were to describe the contribution of the consultation process to total ED length of stay (LOS) through novel metrics and illustrate causes of delay.

Methods:

We conducted a prospective cross-sectional study at three Canadian tertiary care centres. Adult ED patients with requested medical/surgical consultations were enrolled. We created original metric intervals: total consultation time (TCT) defined as the interval from the initial consultation request to the disposition decision, consult response time (CRT) from the request to the consultant arrival, and decision-making interval (DMI) from arrival to the disposition decision. The consultation impact index (CII) was defined as the percentage of ED LOS consumed by the TCT. Reasons for delay were documented if time stamps exceeded preset benchmarks.

Results:

The median TCT for 285 patients was 138 minutes (interquartile range [IQR]: 82–239 minutes), whereas the median total ED LOS was 778 minutes (IQR 485–1,274 minutes). The median CRT was 55 minutes (IQR 21–115 minutes), and the median DMI was 58 minutes (IQR 25–126 minutes). The CII measured 26% (95% CI 23–28). Major contributors to consultation delay included urgent ward issues, simultaneous ED consultations, and the need for additional laboratory or radiographic investigations.

Conclusion:

The consultation process is highly variable and has an important impact on ED LOS. We describe novel measures related to consultation performance and provide an analysis of what causes delays. These results can be used to seek improvements in the consulting process.

Keywords

consultationsmetricsthroughput
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 16 , Issue 3 , May 2014 , pp. 185 - 192
Copyright
Copyright © Canadian Association of Emergency Physicians 2014

References

REFERENCES

1. Rosen, P. Emergency department disposition and knowledge of other specialties. J Emerg Med 1986;4:325–6, doi:10.1016/0736-4679(86)90011-9.Google Scholar
2. Woods, RA, Lee, R, Ospina, MR, et al. Consultation outcomes in the emergency department: exploring rates and complexity. CJEM 2008;10:25–31.CrossRefGoogle ScholarPubMed
3. Lee, RS, Woods, R, Bullard, MJ, et al. Consultations in theemergency department: a systematic review of the literature. Emerg Med J 2008;25:4–9, doi:10.1136/emj.2007.051631.CrossRefGoogle ScholarPubMed
4. Guertler, AT, Cortazzo, JM, Rice, MM. Referral and consultation in emergency medicine practice. Acad Emerg Med 1994;1:565–71, doi:10.1111/j.1553-2712.1994.tb02557.x.Google Scholar
5. Asplin, BR, Majid, DJ, Rhodes, KV, et al. A conceptual model of emergency department overcrowding. Ann Emerg Med 2003;42:181–4, doi:10.1067/mem.2003.302.Google Scholar
6. Yoon, P, Steiner, I, Reinhardt, G. Analysis of factors influencing length of stay in the emergency department. CJEM 2003;5:155–61.Google Scholar
7. Nelson, KA, Boslaugh, SE, Hodge, D 3rd. Risk factors for extremely long length-of-stay among pediatric emergency patients. CJEM 2003;5:155–61.Google Scholar
8. Schull, MJ, Slaughter, PM, Redelmeier, DA. Urban emergency department overcrowding: defining the problem and eliminating misconceptions. CJEM 2002;4:76–83.Google Scholar
9. Drummond, AJ. No room at the inn: overcrowding in Ontario’s emergency departments. CJEM 2002;4:91–7.Google Scholar
10. Derlet, RW, Richards, JR. Overcrowding in the nation’s emergency departments: complex causes and disturbingeffects. Ann Emerg Med 2000;35:63–8, doi:10.1016/S0196-0644(00)70105-3.Google Scholar
11. Beveridge, R, Clarke, B, Janes, L, et al. Canadian Emergency Department Triage and Acuity Scale: implementation guidelines. CJEM 1999;1(3 Suppl):S2–28.Google Scholar
12. Murray, M, Bullard, M, Grafstein, E, CTAS National Working Group; CEDIS National Working Group. Revisions to the Canadian Emergency Department Triage and Acuity Scale implementation guidelines. CJEM 2004;6:421–7.CrossRefGoogle Scholar
13. Bullard, MJ, Unger, B, Spence, J, Grafstein, E; CTAS National Working Group. Revisions to the Canadian Emergency Department Triage and Acuity Scale (CTAS) adult guidelines [published erratum appears in CJEM 2008;10:330]. CJEM 2008;10:136–51.Google Scholar
14. Qureshi, A, Smith, A, Wright, F, et al. The impact of an acute care emergency surgical service on timely surgical decisionmaking and emergency department overcrowding. J Am Coll Surg 2011;213:284–93, doi:10.1016/j.jamcollsurg.2011.04.020.Google Scholar
15. Brenner, BE, Holmes, TM, Simpson, DD, et al. Reducing specialty consultation times in the emergency department. Acad Emerg Med 2004;11:463, doi:10.1197/j.aem.2004.02.244.Google Scholar
16. Cho, SJ, Jeong, J, Han, S, et al. Decreased emergency department length of stay by application of a computerized consultation management system. Acad Emerg Med 2011;18:398–402, doi:10.1111/j.1553-2712.2011.01039.x.Google Scholar