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Hospitalists improve ED throughput at John Hopkins

Hospitalist Leadership Connection, December 9, 2008

Programs that utilize active bed management by hospitalists can speed up ED throughput and reduce ambulance diversion hours, according to a study from John Hopkins Bayview Medical Center and John Hopkins University School of Medicine in Baltimore. The study, called “Active Bed Management by Hospitalists and Emergency Department Throughput,” was published last week in the Annuals of Internal Medicine.

Researchers evaluated whether or not hospitalists lessened ED crowding with adult inpatients during November 2005 to February 2007. During the study, hospitalists at Johns Hopkins made rounds twice a day in the intensive care unit and made regular visits to the ED. They also assessed bed availability, assisted triage, assigned admissions to the department of medicine, and monitored transfers from the ED.

The study show that hospitalist-led bed management reduced the amount of time a patient spent in the ED from about 7.63 hours (458 minutes) to 6 hours (360 minutes), a reduction of 98 minutes. This method also reduced the percentage of hours the ED had to divert ambulances due to overcrowding (yellow alert) by 6%, and the percentage of hours the ED diverted ambulances due to lack of intensive care beds (red alert) by more than a quarter (27%).

The hospitalist-led bed management did not appear to affect length-of-stay, the number intensive care transfers, or mortality rates. Case mix and staffing also remained stable, according to the study.

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