Clinical Decision Support Reduces High-Cost Imaging
Prior research has shown that brain, cervical spine, and pulmonary embolism CT scans are overutilized, low-value diagnostics tests in the ED. For a study, researchers evaluated the impact of evidence-based clinical decision support (CDS) that was integrated into physician electronic health record workflow on overall use and physician-level variability in the use of these three tests. Physicians attempting to order one of the CT tests were met with an alert, led to the appropriate clinical decision rule, and made aware if their order was indicated. Justification could be given to override the alert. Following implementation of the CDS tool, CT brain and cervical spine scans decreased by 10% and 6%, respectively. Pulmonary embolism scan use did not change significantly overall. However, pulmonary embolism scan use decreased 13% for high utilizers at the start of the study, remained unchanged for average users, and increased 40% for low users. A similar pattern was seen for cervical spine scans.
Nursing Hours & ED Throughput Metrics
Patient length of stay (LOS) in the ED remains an important measurable factor in evaluating performance. However, data are lacking on the impact of ED nursing hours on ED LOS and the number of patients who leave without being seen (LWBS) by a provider. For a study involving more than 100,000 ED visits during 2015, researchers recorded daily ED LOS, ED patient volume, the number of patients who LWBS each day, and daily nursing hours. After controlling for daily ED volume and hospital occupancy, the authors found that days with below median nursing hours led to 19.7-minute longer door-to-discharge time per patient and an increase of seven patients per day who LWS when compared with above median nursing hours. However, door-to-admit time was not affected significantly be nursing hours.
Emergency Medicine Residents’ Facebook Behavior
Previous studies have found high rates of Facebook use among physicians and high rates of unprofessional behavior in surgeons and surgical residents as portrayed in their Facebook accounts. Little is known about the frequency and degree of unprofessional conduct that is publicly available through the Facebook profiles of emergency medicine residents. The publicly visible Facebook profiles of residents at one of 77 emergency medicine (EM) residency programs were evaluated for a study, based on a scoring system derived from the Accreditation Council for Graduate Medical Education components of professionalism and the American Medical Association report on professionalism in the use of social media. Of residents with confirmed profiles, 63.2% had no unprofessional content, 29.7% had potentially unprofessional content, and 7.1% had clearly unprofessional content. Men had significantly more clearly unprofessional behavior, but no significant differences were observed by postgraduate year. Alcohol use was the most frequent potentially unprofessional behavior, and expletive use was the most common clearly unprofessional behavior.
Assessing Patients Who LWBS
Long wait times due to increasing capacity issues in EDs has been shown to lead to many patients leaving without being seen (LWBS) by a physician. Few studies have assessed what happens to these patients and their characteristics. Researchers reviewed the cases of patients who checked into the ED triage but LWBS between July 1, 2015 and February 29, 2016 at two teaching hospitals for a study. Of the 3.6% patients—of more than 50,000 ED visits assessed—who LWBS, 16.7% returned to one of the EDs for evaluation within 24 hours. In addition:
- 20.2% of LWBS patients had returned at 48 hours.
- 22.3% of LWBS patients had returned within 72 hours.
- 27.1% of LWBS patients had returned within 7 days.
The investigators suggest that future research seek to assess whether this population has mild issues or is generally so unwell that they cannot tolerate long waits in crowded ED waiting areas.
Cost Savings With RFID
Radio frequency identification (RFID) can be used in the ED to track providers, equipment, and other assets of interest. While RFID has been proposed as a means to streamline operations, reduce waste, and improve patient safety, initial costs to install RFID systems have proven to be a barrier to widespread adoption. Whether or not RFID-assisted search systems lead to costs savings by reducing wasted time has not been well described. For a study, ED nurses, emergency medicine residents, and patient care assistants working at an academic ED that sees 73,000 patients annually were assigned to one of eight clinical scenarios that mimicked frequent daily searches looking for equipment, staff, or patients. Search times with and without RFID were compared. When compared with searches without RFID, searches with RFID reduced search times by 87% across the eight staged asset search scenarios, representing a potential $1.87 million in annual cost savings.
For more information on these studies and others that were presented at ACEP 2016, visit www.acep.org/sa.
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