Code Help: Can This Unique State Regulatory Intervention Improve Emergency Department Crowding?
Authors
Michael, Sean S.Broach, John
Kotkowski, Kevin A.
Brush, David Eric
Volturo, Gregory A.
Reznek, Martin A.
UMass Chan Affiliations
Department of Emergency MedicineDocument Type
Journal ArticlePublication Date
2018-05-01Keywords
emergency department crowdinghospitals
admitting
boarding
length of stay
Emergency Medicine
Health Information Technology
Health Policy
Health Services Administration
Health Services Research
Metadata
Show full item recordAbstract
Introduction: Emergency department (ED) crowding adversely affects multiple facets of high-quality care. The Commonwealth of Massachusetts mandates specific, hospital action plans to reduce ED boarding via a mechanism termed "Code Help." Because implementation appears inconsistent even when hospital conditions should have triggered its activation, we hypothesized that compliance with the Code Help policy would be associated with reduction in ED boarding time and total ED length of stay (LOS) for admitted patients, compared to patients seen when the Code Help policy was not followed. Methods: This was a retrospective analysis of data collected from electronic, patient-care, timestamp events and from a prospective Code Help registry for consecutive adult patients admitted from the ED at a single academic center during a 15-month period. For each patient, we determined whether the concurrent hospital status complied with the Code Help policy or violated it at the time of admission decision. We then compared ED boarding time and overall ED LOS for patients cared for during periods of Code Help policy compliance and during periods of Code Help policy violation, both with reference to patients cared for during normal operations. Results: Of 89,587 adult patients who presented to the ED during the study period, 24,017 (26.8%) were admitted to an acute care or critical care bed. Boarding time ranged from zero to 67 hours 30 minutes (median 4 hours 31 minutes). Total ED LOS for admitted patients ranged from 11 minutes to 85 hours 25 minutes (median nine hours). Patients admitted during periods of Code Help policy violation experienced significantly longer boarding times (median 20 minutes longer) and total ED LOS (median 46 minutes longer), compared to patients admitted under normal operations. However, patients admitted during Code Help policy compliance did not experience a significant increase in either metric, compared to normal operations. Conclusion: In this single-center experience, implementation of the Massachusetts Code Help regulation was associated with reduced ED boarding time and ED LOS when the policy was consistently followed, but there were adverse effects on both metrics during violations of the policy.Source
West J Emerg Med. 2018 May;19(3):501-509. doi: 10.5811/westjem.2018.1.36641. Epub 2018 Mar 8. Link to article on publisher's site
DOI
10.5811/westjem.2018.1.36641Permanent Link to this Item
http://hdl.handle.net/20.500.14038/40622PubMed ID
29760848Related Resources
Rights
Copyright: © 2018 Michael et al. This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) License. See: http://creativecommons.org/licenses/by/4.0/Distribution License
http://creativecommons.org/licenses/by/4.0/ae974a485f413a2113503eed53cd6c53
10.5811/westjem.2018.1.36641
Scopus Count
Except where otherwise noted, this item's license is described as Copyright: © 2018 Michael et al. This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) License. See: http://creativecommons.org/licenses/by/4.0/