DO ADMITTED PATIENTS HELD IN THE EMERGENCY DEPARTMENT IMPACT THE THROUGHPUT OF TREAT-AND-RELEASE PATIENTS

Objective: To examine the impact of reducing ED ''boarders'' (through the use of a short-stay inpatient medicine unit) on the amount of time that treat-and-release patients spend in the ED. Methods: A retrospec tive analysis of hours spent in the ED was made at a university hospit al teaching ED for treat-and-release patients in 4 clinical categories : chest pain, asthma exacerbation, sickle-cell crisis, and seizure. Th e average hours per patient spent in the ED during the 4-month interva ls before (August-November 1993) and after (August-November 1994) the establishment of the short-stay medicine unit were compared. Data were analyzed using the 2-tailed, unpaired t-test. Results: This short-sta y inpatient medicine unit received on average 135 patients per month f rom the ED, with an average length of stay of 2.4 days. The mean (+/-S D) number of admitted patients per day waiting in the ED >8 hours for an inpatient bed dropped from 9.6 +/- 4.2, before the institution of t his unit, to 2.3 +/- 2.6. There was a significant reduction in the ave rage number of hours spent in the ED by treat-and-release patients wit h chest pain (from 7.3 +/- 6.0 to 5.5 +/- 4.8 hr/patient, p < 0.001) a nd asthma exacerbation (from 5.0 +/- 3.6 to 4.2 +/- 2.9 hr/patient, p < 0.05), but not with sickle-cell crisis or seizure, after the impleme ntation of the short-stay unit. Conclusion: Reducing the number of adm itted patients waiting in the ED for inpatient beds, in this case by e stablishment of a short-stay medicine unit, is associated with a decre ase in the interval that treat-and-release patients spend in the ED.