2.50
Hdl Handle:
http://hdl.handle.net/10755/162413
Type:
Presentation
Title:
A Virtual Acute Admission Unit: Preliminary Results
Abstract:
A Virtual Acute Admission Unit: Preliminary Results
Conference Sponsor:Emergency Nurses Association
Conference Year:2010
Author:van der Linden, Christien, RN, MANP, MSCE
P.I. Institution Name:Medical Center Haaglanden, location Westeinde
Title:Clinical Epidemiologist, Emergency Nurse Practitioner
Contact Address:Postbus 432, Westeinde 100, The Hague, 2501 CK, The Netherlands
Contact Telephone:00-31-703302077
Co-Authors:Naomi van der Linden, BSc Organizational Anthropology, MSc Health Economics, BSc Medicine; Lindeboom, PhD; C. Lucas, PhD
[ENA Annual Conference - Research Presentation]

Background: Emergency department overcrowding (EDO) is a widespread problem in the Netherlands and elsewhere. EDO can be aggravated by a lack of unoccupied inpatient beds to admit ED patients. This was the case in the study setting. While there was sub maximal hospital occupancy, hospital wards were reluctant to admit acute patients from other specialties to 'their beds'. Whenever the 'right ward' was fully occupied, the patient needed to be transferred to another hospital, even when there was still capacity in the hospital as a whole. As a result, ED patients requiring hospitalization had to wait in the ED until transfer to another hospital was arranged, thus occupying valuable space in the ED.
To address this problem, some hospitals have turned to opening acute admission units (temporary holding areas) for these patients. However, this is associated with advantages as well as disadvantages, in particular high costs. Therefore, another approach was chosen: implementing a 'virtual' acute admission unit (VAAU) consisting of 15 inpatient regular beds, of which the physical location, on several different departments, was determined on a daily basis. These 'VAAU beds' were used to admit acute patients when an inpatient admission bed on the appropriate floor was not yet available. This intervention was expected to decrease ED throughput problems and transfers to other hospitals.

Purpose: Evaluation of the effects of the VAAU on ED length of stay (LOS) and number of transfers to other hospitals.

Design: A before- and after cohort analysis of four months in 2008 (control period: CP) and the same period in 2009 (intervention period: IP).

Setting: An inner-city, level 1 trauma centre in the Netherlands with >50.000 ED patients per year.

Subjects: All patients registered on working days between 16 P.M. and 8 A.M..

Methods: LOS in the CP was compared to LOS in the IP, for: 1. all presenting patients (N=17308), 2. all admitted patients (N=2411) and 3. those admitted to a VAAU bed (N=1619). Furthermore, the amount of transfers to other hospitals was compared between both periods.
We will correct for casemix, including urgency category, age, admission rates and ICU-admission rates.

Results: ED admissions increased from 8377 (CP) to 8931 (IP). For all presenting ED patients, the median LOS increased with 13 minutes, from 1:34 to 1:47 hours (p=0.000). In the admitted ED patients, median LOS increased with 10 minutes, from 3:09 to 3:19 hours (p=0.038). In admitted patients assigned to a VAAU bed, the median LOS increase was not significant (9 minutes, p=0.655).
The number of patients that had to be transferred to other hospitals decreased from ten to one (p=0.000).

Implications: These preliminary results show that almost no transfers to other hospitals were necessary in the VAAU setting. Furthermore, the LOS of admitted patients assigned to a VAAU bed has increased less then the LOS of other patients. One should be careful interpreting these results since important further analyses are awaited. Qualitative research has shown that ED nursesÆ experiences with the VAAU are positive.
Repository Posting Date:
27-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Emergency Nurses Association

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleA Virtual Acute Admission Unit: Preliminary Resultsen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162413-
dc.description.abstract<table><tr><td colspan="2" class="item-title">A Virtual Acute Admission Unit: Preliminary Results<br/></td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Emergency Nurses Association</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2010</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">van der Linden, Christien, RN, MANP, MSCE</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Medical Center Haaglanden, location Westeinde</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Clinical Epidemiologist, Emergency Nurse Practitioner</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">Postbus 432, Westeinde 100, The Hague, 2501 CK, The Netherlands</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">00-31-703302077</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">c.van.der.linden@mchaaglanden.nl</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Naomi van der Linden, BSc Organizational Anthropology, MSc Health Economics, BSc Medicine; Lindeboom, PhD; C. Lucas, PhD</td></tr><tr><td colspan="2" class="item-abstract">[ENA Annual Conference - Research Presentation] <br/><br/>Background: Emergency department overcrowding (EDO) is a widespread problem in the Netherlands and elsewhere. EDO can be aggravated by a lack of unoccupied inpatient beds to admit ED patients. This was the case in the study setting. While there was sub maximal hospital occupancy, hospital wards were reluctant to admit acute patients from other specialties to 'their beds'. Whenever the 'right ward' was fully occupied, the patient needed to be transferred to another hospital, even when there was still capacity in the hospital as a whole. As a result, ED patients requiring hospitalization had to wait in the ED until transfer to another hospital was arranged, thus occupying valuable space in the ED.<br/>To address this problem, some hospitals have turned to opening acute admission units (temporary holding areas) for these patients. However, this is associated with advantages as well as disadvantages, in particular high costs. Therefore, another approach was chosen: implementing a 'virtual' acute admission unit (VAAU) consisting of 15 inpatient regular beds, of which the physical location, on several different departments, was determined on a daily basis. These 'VAAU beds' were used to admit acute patients when an inpatient admission bed on the appropriate floor was not yet available. This intervention was expected to decrease ED throughput problems and transfers to other hospitals.<br/><br/>Purpose: Evaluation of the effects of the VAAU on ED length of stay (LOS) and number of transfers to other hospitals. <br/><br/>Design: A before- and after cohort analysis of four months in 2008 (control period: CP) and the same period in 2009 (intervention period: IP). <br/><br/>Setting: An inner-city, level 1 trauma centre in the Netherlands with &gt;50.000 ED patients per year.<br/><br/>Subjects: All patients registered on working days between 16 P.M. and 8 A.M.. <br/><br/>Methods: LOS in the CP was compared to LOS in the IP, for: 1. all presenting patients (N=17308), 2. all admitted patients (N=2411) and 3. those admitted to a VAAU bed (N=1619). Furthermore, the amount of transfers to other hospitals was compared between both periods.<br/>We will correct for casemix, including urgency category, age, admission rates and ICU-admission rates. <br/><br/>Results: ED admissions increased from 8377 (CP) to 8931 (IP). For all presenting ED patients, the median LOS increased with 13 minutes, from 1:34 to 1:47 hours (p=0.000). In the admitted ED patients, median LOS increased with 10 minutes, from 3:09 to 3:19 hours (p=0.038). In admitted patients assigned to a VAAU bed, the median LOS increase was not significant (9 minutes, p=0.655). <br/>The number of patients that had to be transferred to other hospitals decreased from ten to one (p=0.000).<br/><br/>Implications: These preliminary results show that almost no transfers to other hospitals were necessary in the VAAU setting. Furthermore, the LOS of admitted patients assigned to a VAAU bed has increased less then the LOS of other patients. One should be careful interpreting these results since important further analyses are awaited. Qualitative research has shown that ED nurses&AElig; experiences with the VAAU are positive.<br/></td></tr></table>en_GB
dc.date.available2011-10-27T10:27:48Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:27:48Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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