Analysis and Improvising Working Practices in the ER

Characterizing ER Activities for Failure Prevention

Analysis of electronic files of patients presenting to the emergency department to improve current practice

Study Overview

• Status: Completed
• Conditions: EMERGENCY MEDICINE
• Intervention / Treatment: Other: No intervention

Detailed Description

Overcrowding in the emergency department (ED) is a pressing healthcare issue globally and has been shown to negatively affect the quality of treatment, clinical outcomes and patient satisfaction.

In recent years, an increasing number of studies have tried to implement changes in the ED to increase efficiency and thereby reduce the length of stay (LOS). Examples to these efforts include physician triage, expanding the nursing scope of practice and patient-flow design (e.g., creating fast track units) in the ED. Importantly, not all intuitive changes in the ED resulted in the reduction of LOS Therefore, implementing changes in the ED must be done with caution and preceded with a cost-benefit analysis of the effects of the intervention using available retrospective data.

This research was conducted in the ED of Sheba Medical Center (SMC), a tertiary government-owned hospital in Israel with 1400 beds. This study is a retrospective medical record review of patients admitted to the adult primary SMC ED. The study sample comprises all the walk-in patients that visited the ED between January 2013 and December 2017. The data here does not include other EDs located elsewhere in SMC, (e.g., pediatric ED, gynecology ED, ophthalmology ED, and psychiatric ED). All admissions files in SMC ED are recorded in a computerized system with negligible exceptions (such as power outage and connection or server maintenance). The time and date of every change in the electronic files are also recorded in the system. Therefore, it is possible to track the waiting times as well as the full content of the admission file.

The aim of this study is to identify and analyze potential modifications in current ED practice which may improve outcomes such as LOS, missed diagnosis, leaving without being seen, patient satisfaction, etc.

• Study Type: Observational
• Enrollment (Actual): 500000

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: N/A
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

All the patients admitted to the adult primary SMC ED ED between August 2014 and December 2017.

. The data here did not include other EDs located elsewhere in SMC, (e.g., pediatric ED, gynecology ED, ophthalmology ED and psychiatric ED).

Description

Inclusion Criteria:

• all the patients that visited the SMC - ED between August 2014 and December 2017

Exclusion Criteria:

• patients in which the electronic file is absent

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Length of stay	The time between admitting the patient to the ED and the time of decision to release or admit to hospital	Starting from January1st 2014 until January 30th 2018
left without being seen	amount of patients who leave the ED without being seen by a physician	Starting from January1st 2014 until January 30th 2018
missed diagnosis	Change of preliminary diagnosis made by ED physician compared to diagnosis after admission to hospital, or after readmission to ED	Starting from January1st 2014 until January 30th 2018
physician mistakes	Errors made by ED physician in the management of patients in the ED	Starting from January1st 2014 until January 30th 2018
Admission to hospital	The rate of hospitalization compred to the rate of discharge from ED	Starting from January1st 2014 until January 30th 2018
return to ED after discharge	patients returning to hospital within 30 days of discharge from ED	Starting from January1st 2014 until January 30th 2018
Time till being seen by a physician	We measure the time it took for the patient to be seen by an ED physician	Starting from January1st 2014 until January 30th 2018

Collaborators and Investigators

• Sponsor: Sheba Medical Center
• Collaborators: Dr. Yahel Giat; Pr. Merav Lidar; Dr. Michael Dreyfuss; Dr. Avinoah Irony; Dr. Gabrieal Breuer

Study record dates

Study Major Dates

• Study Start (Actual): August 1, 2013
• Primary Completion (Actual): December 31, 2017
• Study Completion (Actual): December 31, 2017

Study Registration Dates

• First Submitted: May 5, 2019
• First Submitted That Met QC Criteria: May 7, 2019
• First Posted (Actual): May 9, 2019

Study Record Updates

• Last Update Posted (Actual): May 9, 2019
• Last Update Submitted That Met QC Criteria: May 7, 2019
• Last Verified: May 1, 2019

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pathologic Processes; Disease Attributes; Emergencies
• Other Study ID Numbers: 5132-18-SMC

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: all data is encrypted and unidentified