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dc.contributor.authorMichael, Sean S.
dc.contributor.authorBroach, John
dc.contributor.authorKotkowski, Kevin A
dc.contributor.authorBrush, David Eric
dc.contributor.authorVolturo, Gregory A.
dc.contributor.authorReznek, Martin A
dc.date2022-08-11T08:09:50.000
dc.date.accessioned2022-08-23T16:45:08Z
dc.date.available2022-08-23T16:45:08Z
dc.date.issued2018-05-01
dc.date.submitted2018-05-30
dc.identifier.citation<p>West J Emerg Med. 2018 May;19(3):501-509. doi: 10.5811/westjem.2018.1.36641. Epub 2018 Mar 8. <a href="https://doi.org/10.5811/westjem.2018.1.36641">Link to article on publisher's site</a></p>
dc.identifier.issn1936-900X (Linking)
dc.identifier.doi10.5811/westjem.2018.1.36641
dc.identifier.pmid29760848
dc.identifier.urihttp://hdl.handle.net/20.500.14038/40622
dc.description.abstractIntroduction: 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.
dc.language.isoen_US
dc.relation<p><a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&list_uids=29760848&dopt=Abstract">Link to Article in PubMed</a></p>
dc.rightsCopyright: © 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/
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/
dc.subjectemergency department crowding
dc.subjecthospitals
dc.subjectadmitting
dc.subjectboarding
dc.subjectlength of stay
dc.subjectEmergency Medicine
dc.subjectHealth Information Technology
dc.subjectHealth Policy
dc.subjectHealth Services Administration
dc.subjectHealth Services Research
dc.titleCode Help: Can This Unique State Regulatory Intervention Improve Emergency Department Crowding?
dc.typeJournal Article
dc.source.journaltitleThe western journal of emergency medicine
dc.source.volume19
dc.source.issue3
dc.identifier.legacyfulltexthttps://escholarship.umassmed.edu/cgi/viewcontent.cgi?article=4438&amp;context=oapubs&amp;unstamped=1
dc.identifier.legacycoverpagehttps://escholarship.umassmed.edu/oapubs/3427
dc.identifier.contextkey12222321
refterms.dateFOA2022-08-23T16:45:08Z
html.description.abstract<p>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.</p> <p>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.</p> <p>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.</p> <p>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.</p>
dc.identifier.submissionpathoapubs/3427
dc.contributor.departmentDepartment of Emergency Medicine
dc.source.pages501-509


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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/
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/