The objective of this article was to explore new intake models for processing patients into the emergency department (ED) and disseminate these new ideas. In the fall of 2008, the Board of Directors of the Emergency Department Benchmarking Alliance (EDBA) identified intake as an area of focus and asked its members to submit new intake strategies alternative to traditional triage. All EDBA members were invited to participate via an e-mail survey. New models could be of their own design or developed by another organization and presented with permission. In all, 25 departments provided information on intake innovations. These submissions were collated into a document that outlines some of the new models. Collaborative methodology promoted the diffusion of innovation in this organization. The results of the project are presented here as an original article that outlines some of the new and mostly unpublished work occurring to improve the intake process into the ED.
Owens P., Elixhauser A.Hospital Admissions That Began in the Emergency Department. Rockville, MD: Agency for Healthcare Research and Quality ; 2006. HCUP Healthcare Cost and Utilization Project, Statistical Brief 1.
2.
Centers for Disease Control and Prevention.National hospital ambulatory medical care survey: 2006 emergency department summary. National Health Statistics Reports . http://www.cdc.gov/nchs/data/nhsr/nhsr007.pdf . Accessed November 27, 2009.
3.
Humphries K., Thompson C.VHA Performance measures and benchmarks. Paper presented at: VHA’s Conference on Optimizing Functional Capacity; November 2006; Tucson, AZ.
4.
The Joint Commission.Sentinel event alert: delays in treatment. http://www.jointcommission.org/SentinelEvents/SentinelEventAlert/sea_26.htm. Accessed November 27, 2009.
5.
Emergency Department Pulse Report 2008.Patient Perspectives on American Health Care. South Bend, IN: Press Ganey Associates; 2008.
6.
Urgent Matters PatientFlow Newsletter.Engaging staff to reduce ED wait times to 30 minutes: recognition, rewards and review of data energizes Chicago’s Mount Sinai. Available at: http://urgentmatters.org/346834/318749/318750/318751 . Accessed November 27, 2009.
7.
Busy ED keeps promise of "door to doc" in 31 minutes. Hosp Case Manag. 2008;16:87-89.
8.
Patel PB, Vinson DRTeam assignment system: expediting emergency department care efficiency. Ann Emerg Med. 2005;46:499-506.
9.
Kyriacou DN, Ricketts V., Dyne PL, McCollough MD, Talan DAA 5-year time study analysis of emergency department patient care efficiency . Ann Emerg Med. 1999;34: 326-335.
10.
Chan TC, Killeen JP, Kelly D., Guss DAImpact of rapid entry and accelerated care at triage on reducing emergency department wait times, lengths of stay and rate of left without being seen . Ann Emerg Med. 2005;46:491-497.
11.
Khot UN, Johnson ML, Ramsey C., et al. Emergency department physician activation of the catheterization laboratory and immediate transfer to an immediately available catheterization laboratory reduce door to balloon time in ST-elevation myocardial infarction . Circulation. 2007; 116:67-76.
12.
Diericks DB , Roe MT, Chen AY, et al. Prolonged emergency department stays of non-ST segment elevation myocardial infarction patients are associated with worse adherence to the American Cardiology/American Heart Association guidelines for management and increased adverse events. Ann Emerg Med. 2007;50:489-496.
13.
Semplicine A., Benetton V., Macchini E., et al. Intravenous thrombolysis in the emergency department for the treatment of acute ischemic stroke. Emerg Med J. 2008;25:403-406.
Dean NC, Bateman KA, Donnelly SM, Silver MP, Snow GL, Hale D.Improved clinical outcomes with utilization of a community acquired pneumonia guideline. Chest. 2006;130:794-799.
16.
Bernstein SL , Aronsky D., Duseja R., et al. The effect of emergency department crowding on clinically oriented outcomes. Acad Emerg Med. 2008;15:1-10.
17.
Joint Commission Resources.2009Comprehensive Accreditation Manual for Hospitals: The Official Handbook. Oakbrook Terrace, IL: Joint Commission on Accreditation of Healthcare Organizations (The Joint Commission); 2008 .
18.
The National Quality Forum.NQF endorses measures to address care coordination and efficiency in hospital emergency departments [press release]. http://urgentmatters.org/media/file/NQF%20Press%20Release.pdf . Published October 29, 2008. Accessed November 27, 2009.
19.
Michalke JA, Patel SG, Siler Fisher A., et al. Emergency department size determines the demographics of emergency department patients. Ann Emerg Med. 2005;46(3, suppl):39.
20.
Siler Fisher A., Hoxhaj S., Patel SG, et al. Predicting patient volume per hour . Ann Emerg Med. 2005;46(3, suppl):6-7.
21.
Welch S., Allen TACensus, acuity and ED operations by time of day at a level one trauma and tertiary care center. Jt Comm J Qual Patient Saf. 2007;33:247-255.
22.
Hoxhaj S., Jones LL, Fisher AS, Moseley MG, Rogers J., Reese CL IV. Nurse staffing levels affect the number of emergency department patients that leave without treatment. Acad Emerg Med. 2004 ;11:459.
23.
Jensen K., Mayer T., Welch SJ, Harade C.Leadership for Smooth Patient Flow. Chicago: ACHE Management Series, Health Administration Press; 2006 .
24.
Jones SS, Allen TA, Flottemesch TJ, Welch SJAn independent evaluation of four quantitative emergency department crowding scales. Acad Emerg Med. 2006;13:1204-1211.
25.
Jones S., Thomas A., Evans RS, Welch SJ, Haug PJ, Snow GLForecasting daily patient volumes in the emergency department. Acad Emerg Med. 2008;15:159-170.
26.
Welch SJ, Augustine J., Camargo C., Reese C.Emergency department performance measures and benchmarking summit. Acad Emerg Med. 2006;13:1074-1080
27.
Wilson A., Shifaza F.An evaluation of the effectiveness and acceptability of nurse practitioners in an adult emergency department. Int J Nurs Pract. 2008;14:149-156.
28.
Sakr M., Kendall R., Angus J., Sanders A., Nicholl J., Wardrope J.Emergency nurse practitioners; a three part study in clinical and cost effectiveness . Emerg Med J. 2003;20:158-163.
29.
Levine SD, Colwell CB, Pons PT, Gravitz C., Haukoos JS, McVaney KEHow well do paramedics predict admission to the hospital? A prospective study . J Emerg Med. 2006;31:1-5. 30. Kosowsky JM, Schindel S., Liu T., Hamilton C., Pancioli AMCan emergency department nurses predict patients’ dispositions?Am J Emerg Med. 2001;19:10-14.
30.
Sinuff T., Adhikari NK, Cook DJ, et al. Mortality predictions in the intensive care unit: comparing physicians with scoring systems. Crit Care Med. 2006;34:878-885.
31.
Rocker G., Cook D., Sjokvist P., et al. Clinician predictions of intensive care unit mortality. Crit Care Med. 2004;32: 1149-1154.
32.
Rodriguez RM , Wang NE, Pearl RGPrediction of poor outcome of intensive care unit patients admitted from the emergency department. Crit Care Med. 1997;25:1801-1806.
33.
Dent AW, Weiland TJ, Vallender L., et al. Can medical admission and length of stay be accurately predicted by emergency staff, patients or relatives?Aust Health Rev . 2007;31:633-641.
34.
Terris J., Leman P., O’Connor N., Wood R.Making an IMPACT on emergency department flow: improving patient processing assisted by consultant at triage. Emerg Med J. 2004;21:537-541.
35.
Travers JP, Lee FCAvoiding prolonged waiting time during busy periods in the emergency department: is there a role for the senior emergency physician in triage? Eur J Emerg Med. 2006;13:342-348.
36.
Choi YF, Vong TW, Lau CCTriage rapid assessment by doctor (TRIAD) improves waiting time and processing time of the emergency department. Emerg Med J. 2006;23:262-265.
37.
Borger R.Hospital and county case studies. Paper presented at: The California ED Diversion Project Meeting; May 27, 2008 ; Los Angeles, CA.
38.
McD Taylor D., Bennett DM, Cameron PAA paradigm shift in the nature of care provision in emergency departments. Emerg Med J. 2004 ;21:681-684.
39.
Mayer T.Team triage and treatment (T3): quality improvement data from Fairfax Inova Hospital. Paper presented at: ED Benchmarks 2005 Conference; March 4, 2005; Orlando, FL.
40.
Richardson JR, Braitberg G., Yeoh MJMultidisciplinary assessment at triage. Emerg Med Australas. 2004;16:41-46.
41.
Besson K.Care initiation area yield dramatic results. ED Manag. 2009;21:28-30.
42.
Protocols and Process Improvement Workgroup.IHI clinical and operational improvements for the emergency department, 2007-2008. Paper presented at: IHI ED Collaborative Meeting; June 17, 2008; Atlanta, GA.
43.
Welch S.Quality matters.ED redesign: zones operate like mini ED’s. Emerg Med News. 2008 ;30:4.
44.
Vega V., McGuire SJSpeeding up the emergency department: the RADIT emergency program at St. Joseph Hospital of Orange. Hosp Top. 2007;85:17-24.
45.
Augustine J.Designing for the future. Paper presented at: The First Annual Emergency Department Redesign Course; Atlanta’s Mart, Atlanta, GA, December 10-12, 2008.
46.
Savic T., Pavesic N.Personal recognition based on image of the palmar surface of the hand. Pattern Recognit. 2007;40: 3152-3163.
47.
Guenther J.Palmar scanning to facilitate ED intake. Paper presented at: Summit Exploring New Intake Models Into the Emergency Department ; February 25-26, 2010; Salt Lake City, UT .
48.
Benarola M. , Elinson R., Zarnke K.Patient-directed intelligent and interactive computer medical history gathering systems; a utility and feasibility study in the emergency department. Int J Med Inform. 2007;76:283-288.
49.
Davidson S. , Koenig KL, Cone DCDaily patient flow is not surge: "management is prediction." Acad Emerg Med. 2006;13:1095-1096.
50.
McGrayne J.Seventeen years of ED consulting: data from the Premier Consulting Database . Paper presented at: Taking Your ED From Good to Great: First Annual Advanced ED Operations Course; March 13-15, 2009; Las Vegas, NV.
51.
Good Morning America.Illinois woman’s ER wait death ruled homicide. http://abcnews.go.com/GMA/Health/story?id=2454685&page=1. Accessed January 11, 2010.
52.
Autopsy: Blood clots caused NY ER waiting room death. CNN.com. Reported in http://www.emsresponder.com/web/online/Top-EMS_News/Autopsy-Blood-Clots-Cause. Accessed 10/21/08.
53.
Woman died in ER Lobby as 911 refuses to help. Associated Press. Reported in http://www.msnbc.com/id/19207050/ . Accessed 10/21/08.
54.
Wilson MJ, Nguyen K.Bursting at the Seams: Improving Patient Flow to Help America’s Emergency Departments. Washington DC: The George Washington University Medical Center, School of Public Health and Health Services, Department of Health Policy; 2004.
