Bedside Teaching on Time to Disposition Improves Length of Stay for Critically-ill Emergency Departments Patients

Abstract

Introduction: We tested the effect of a brief disposition process intervention on residents’ time todisposition and emergency department (ED) length of stay (LOS) in high acuity ED patients.Methods: This was a quasi-experimental study design in a single teaching hospital where ED residentsare responsible for administrative bed requests for patients. Enrollment was performed for interventionand control groups on an even-odd day schedule. Inclusion criteria were ED patients triaged asEmergency Severity Index (ESI) 1 and 2. In the intervention group, the attending physician prompted theresident to make the disposition immediately after the evaluation of resuscitation patients. In the controlgroup, the attending physicians did not intervene in the disposition process unless more than 2 hourspassed without a disposition. Main outcomes were time to disposition and total ED LOS.Results: A total of 104 patients were enrolled; 53 (51%) in the intervention group and 51 (49%) inthe control group. After controlling for ESI and resident training year, mean disposition time wassignificantly shorter in the intervention group by 41.4 minutes (95% CI: 32.6-50.1). LOS was alsoshorter in the intervention group by 93.3 minutes (95% CI: 41.9-144.6).Conclusion: Prompting residents to enter administrative disposition orders in high acuity patientsis associated with significant reduction in both time to disposition and ED LOS.

Keywords

• emergency medicine
• patient education
• health education
• clinical practice