Decreasing boarders in the emergency department by reducing clerical work in the discharge process of in-hospital patients in Brazil – an interrupted time-series analysis

Abstract

Abstract Background Emergency Department (ED) boarding is related to in-hospital patients' discharge since no beds will be available for receiving ED patients if there is a delay for patients in the yard leaving the hospital. New techniques implemented in hospital institutions, such as digital signatures to facilitate clerical work improve these processes. We evaluated the impact of expediting patients' discharge after medical orders with the number of patients with an unplanned hospital admission from the Hospital Out Clinic directed to ED for waiting for an available bed in a public tertiary hospital in Brazil. Methods We conducted a quasi-experimental study before and after an intervention. It consisted of an encrypted digital signature to reduce clerical work and expedite the patient's release from the institution after medical discharge. We used an interrupted time-series analysis based on administrative data (number of hospital discharges, bed turnover, the time between medical discharge, and the time the patient effectively left the hospital) from 2011 to 2020. Results We enrolled 210,496 patients admitted to the hospital from January 2011 to December 2020. Of those, 69,897(33%) composed the group after the intervention. There was no difference between the groups' gender, age distribution, the proportion of surgical patients, or in-hospital stay (≤ 7 or > 7 days). The interrupted time series analysis for the time from medical order to effectively hospital discharge showed an immediate change in level (Coefficient β2 -3.6 h—95% confidence interval -3.9;-3.4), but no a difference in the slope of the behavior of the post-intervention curve (β3 0.0005 coefficient—95% confidence interval -0.0040;0.0050). For the number of patients directed to ED, we observed no immediate change in level (Coefficient β2 -0.84 patients—95% confidence interval -0.33;0.16), but a difference in the slope of the behavior of the post-intervention curve (β3 0.0005 coefficient—95% confidence interval -0.0040;0.0050). Conclusion Reducing clerical work and expediting patient discharge was associated with decreased potential boarders to ED.

Keywords

• Patient discharge
• Length of stay
• Six sigma and lean
• Hospital quality
• Electronic health records
• Digital signature