Reducing Length of Stay in the Emergency Department

June 10, 2017 updated by: Wan-Ching Lien, National Taiwan University Hospital Hsin-Chu Branch

Reducing Length of Stay in the Emergency Department: Analyzing the Factors and Quality Improvement Interventions

Emergency department (ED) crowding has become an international challenge in the recent decades.

Length of stay (LOS) is a useful marker to monitor ED crowding. Searching for the possible causes and reducing barriers may have the greatest impact on EDLOS.

Therefore, the investigators assembled a multidisciplinary team for improvement of the ED process, to undergo assessments of ED patient flow with the spirit of lean-sigma methodologies. The objectives of this study were to evaluate a Lean-sigma-based initiative to lessen EDLOS.

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Completed

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.

Detailed Description

Lean aims to smooth out the workflow and to eliminate wastes. In the ED settings, lean principles can display the process of the ED patient flow. Six sigma, a complementary strategy, has the merit to compensate the potential weakness of Lean through a data-driven process. Currently, a combination of Lean and Six sigma methodologies develops to solve the problems of workflow.

It became clear that concurrent multifaceted interventions were needed to reduce EDLOS. Therefore, the investigators assembled a multidisciplinary quality improvement team for improvement of the ED process, to undergo assessments of ED patient flow with the spirit of lean-sigma methodologies. The objectives of this study were to evaluate a Lean-sigma-based initiative to lessen EDLOS.

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Observational

Enrollment (Actual)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
72000

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

  • Child
  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Sampling Method

Non-Probability Sample

Study Population

The patients were registered in the ED of the Hsin-Chu branch from Jan, 2015 to Dec, 2015.

Description

Inclusion Criteria:

  • the patients were registered in the ED from Jan, 2015 to Dec, 2015.

Exclusion Criteria:

  • the patients were excluded because of left without seeing a physician.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

Cohorts and Interventions

Group / Cohort

Group / Cohort

A group or subgroup of participants in an observational study that is assessed for biomedical or health outcomes.
Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.
to reduce ED length of stay
to reduce ED length of stay to lessen ED crowding by using Lean-sigma management and quality improvement interventions including reducing boarding time and medical decision time.
Behavioral: Quality improvement (QI) interventions

1. The ED admissions exhibited prolonged length of stay.

2. The Interventions for Reducing Medical Decision Time:

  1. The ED director created QI education sessions and reported monthly QI outcomes.
  2. The ED nurses reported the current number of ED admission patients twice a day to the director. The director summarized the bed requests to the administrative personnel.
  3. The nurses reported the in-scene complicated cases to the ED director. The director would give an assistance in managing these cases.

3. The Interventions for Reducing Boarding Time

  1. The ED patients could be admitted before 8 a.m. if the bed was vacant.
  2. The ED director initiated an on-line meeting at 8 a.m. and 4 p.m.
  3. Monthly QI outcomes were reported in the hospital affairs meeting.

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
length of stay for ED admissions.
Time Frame: 12 months
Length of stay was defined as the time from patient registration to leaving the ED.
12 months

Secondary Outcome Measures

Secondary Outcome Measures

In a clinical study's protocol, a planned outcome measure that is not as important as the primary outcome measure for evaluating the effect of an intervention but is still of interest. Most clinical studies have more than one secondary outcome measure.
Outcome Measure
Measure Description
Time Frame
boarding time for ED admissions
Time Frame: 12months
Boarding time was defined as the time from decision for admission to leaving the ED.
12months
decision time for ED admissions
Time Frame: 12 months
Decision time was defined as the time from patient registration to decision for disposition.
12 months
the percentage of LOS over 24 hours in all ED patients.
Time Frame: 12 months
The percentage was defined as patients staying at the ED over 24 hours/total ED visits.
12 months

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
National Taiwan University Hospital Hsin-Chu Branch

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
January 1, 2015

Primary Completion (Actual)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
December 31, 2015

Study Completion (Actual)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
December 31, 2015

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
June 4, 2017

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
June 10, 2017

First Posted (Actual)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
June 14, 2017

Study Record Updates

Last Update Posted (Actual)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
June 14, 2017

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
June 10, 2017

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
June 1, 2017

More Information

Terms related to this study

Additional Relevant MeSH Terms

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • 105-061-E

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

YES

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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