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Emergency department clinical redesign, team‐based care and improvements in hospital performance: A time series analysis
Author(s) -
Dinh Michael M,
Green Timothy C,
Bein Kendall J,
Lo Serigne,
Jones Aaron,
Johnson Terence
Publication year - 2015
Publication title -
emergency medicine australasia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.602
H-Index - 52
eISSN - 1742-6723
pISSN - 1742-6731
DOI - 10.1111/1742-6723.12424
Subject(s) - medicine , emergency department , emergency medicine , intervention (counseling) , interrupted time series analysis , autoregressive integrated moving average , interrupted time series , medical emergency , psychological intervention , nursing , time series , statistics , mathematics , machine learning , computer science
Objective The objective was to evaluate the impact of an ED clinical redesign project that involved team‐based care and early senior assessment on hospital performance. Methods This was an interrupted time series analysis performed using daily hospital performance data 6 months before and 8 months after the implementation of the clinical redesign intervention that involved E mergency C onsultant‐led team‐based care, redistribution of ED beds and implementation of a senior nursing coordination roles in the ED . The primary outcome was the daily N ational E mergency A ccess T arget ( NEAT ) performance (proportion of total daily ED presentations that were admitted to an inpatient ward or discharged from ED within 4 h of arrival). Secondary outcomes were daily ALOS in ED , inpatient C linical E mergency R esponse System ( CERS ) calls and hospital mortality. Autoregressive Integrated Moving Average analysis was used to model NEAT performance. Hospital mortality was modelled using negative binomial regression. Results After adjusting for patient volume, inpatient admissions, ambulance, hospital occupancy, weekends ED Consultant numbers, weekends and underlying trends, there was a 17% improvement in NEAT associated with the post‐intervention period (95% CI 12, 19% P < 0.001). There was no change in the number of CERS calls and the median daily hospital mortality rate reduced from 1.04% to 0.96% ( P = 0.025). Conclusion An ED ‐focused clinical redesign project was associated with a 17% improvement in NEAT performance with no evidence of an increase in clinical deterioration on inpatient wards and evidence for an improvement in hospital mortality.