175: Emergency Department Inpatient Bed Management Inventory System

175 Emergency Department Inpatient Bed ManagementInventory System

Shah S, Silva J, Ward E, Rumoro D/Rush University Medical Center, Chicago, IL

Study Objective: Emergency department (ED) crowding is an important issueaffecting patient care, quality, and safety as well as increasing health care costs. Toimprove these factors, streamlining ED operations and reducing waste (ie, delays) areessential. One of the areas to improve ED throughput is to reduce disposition delays,which are divided into time-to-bed-ready and bed-ready-to-patient-out delays. Thus,the objective of the project is to develop a quantitative methodology to reduce EDcrowding and increase ED capacity by eliminating process (time to bed ready) delaysat ED disposition.

Methods: Theoretical inventory bed management policy (IBMP) was developedand applied (current and proposed strategies) to a large academic medical center(AMC) with a 34-bed ED to reduce delays associated with ED patient disposition toinpatient general medicine beds. The goal of IBMP is to optimally balance betweenadditional charges/revenue opportunities for ED and maximum utilization ofrequested inpatient beds. The data elements utilized for this study included the timeto bed ready delays, type of bed, day of week, hour of the day, distribution of bedrequest, and financial charges (ie, ED charges per hour per patient and generalmedicine bed charges per day).

Results: Based on the policy, the recommended general medicine bed requests,for the AMC with 34 ED beds, was 14, 12, 10, and 8 general medicine beds forMonday-Thursday, Friday, Saturday, and Sunday, respectively. The anticipatedadditional charges (revenue) in the first year and each subsequent year were estimatedat $1.47 million (revenue � $513,000) and $160,000 (revenue � $50,000),respectively with the time to bed ready substantially (� 0 minute) reduced.

Conclusion: Apart from improving the direct outcomes such as time to bed readydelays and financial profitability, IBMP will also improve patient and staffsatisfaction, length of stay, and left without been seen statistics. The first steps inimplementing the IBMP intervention were to place the bed request demands per dayof the week on the capacity management dashboard, which allows bed controllers toplan for anticipated ED to inpatient bed requests. Full implementation will result inadditional ED capacity and further streamlining of ED operations.

176 Evolution of Door to Electrocardiogram Times Afteran Educational Strategy in Patients PresentingWith Chest Pain to the Emergency Department ina Chilean Academic Center

Aguilera P, Altamirano R, Bellolio M, Pineda N, Morales JF, Alcayaga A,Gabrielli L, Castro P, Mardonez JM/Pontificia Universidad Catolica de Chile,Santiago, Chile; Mayo Clinic, Rochester, MN

Study Objective: To evaluate the effect over time of an educational strategy forreduction on door to ECG times (D-ECG) among patients presenting with chestpain (CP).

Methods: This was a prospective cohort study of door to first ECG times forpatients presenting to an urban, academic emergency department (ED) in Santiago,Chile, with non traumatic CP. All patients with CP who had an ECG recordedduring the ED evaluation were included. Our previous study showed a significantreduction in D-ECG times one month after intervention. The intervention consistedon education to all the ED staff about the importance of providing prompt care ofCP patients, as well as letting the staff know that the D-ECG time and final EDdiagnosis will be recorded.

Times were collected for 5 consecutive months and were compared with thetimes before the intervention. D-ECG times did not follow a normal distribution,Wilcoxon rank sum test was used, and median with interquartile ranges (IQR) werereported.

Results: 711 patients presenting with CP to the ED were included in this study;there were 163 patients in the pre-intervention (PRE) period, and 548 in the post-intervention (POST) period (months 1–5).

The ED diagnosis for the PRE cohort was: 20.3% acute coronary syndrome(ACS), defined as myocardial infarction or unstable angina, and 79.8% non-coronaryCP (NC-CP), including any other non traumatic chest pain etiologies. In the POSTcohort, the diagnosis was 23.7% ACS and 76.3% NC-CP. The difference indiagnosis PRE vs POST was not significant (p�0.35).

The median D-ECG time PRE was 29 minutes (min) (IQR 15 to 52), andPOST was 15 min (IQR 8 to 33), (p�0.0001). There was a significant difference in

D-ECG times between PRE and month 1 (p�0.0001), month 2 (p�0.0001), month3 (p�0.0001), month 4 (p�0.0001), and month 5 (p�0.0001). See tables below.

In the POST cohort, patients with final diagnosis of ACS had significantlyshorter D-ECG times when compared to NC-CP, with a median D-ECG time 10min for ACS (IQR 5 to 20), versus 20 min (IQR 10 to 41) for NC-CP (p�0.0001).

In patients with final diagnosis of ACS and with final diagnosis of NC-CP, therewas a significant difference in D-ECG times between PRE and each following month,except for month 5 in de ACS group that was not significant (p�0.53).

Conclusions: The educational intervention significantly reduced overall door toECG times during the study period. This intervention effectively maintained D-ECGtimes within current national recommendations. However, there is a trend in theACS group to returning to baseline times, suggesting that a new intervention isneeded after this period.

Further work should be done to explore additional strategies that focus onstandardized process improvement to benefit patients presenting to the ED with CPand possible ACS.

177 A Comparative Analysis of Screening HypertensivePatients for Left Ventricular Abnormality WithElectrocardiograph and NT-proBNP

Chandra A, Freeman D, Mani G, Drake W, Limkakeng A/Duke University MedicalCenter, Durham, NC

Study Objective: A new heart failure (HF) classification system recommendstherapeutic interventions performed on hypertensive patients before the appearanceof left ventricular dysfunction symptoms in order to reduce the morbidity andmortality of HF. We evaluated the effectiveness of electrocardiograph (ECG), NT-proBNP, and ECG with NT-proBNP in identifying left ventricular abnormality.

Methods: This was an interventional, prospective trial performed at an urban,tertiary care hospital. Convenience sampling was used to identify and enroll patientswith two emergency department blood pressure (BP) measurements in the JNC-7Stage 2 category. Patients were excluded if they exhibited moderate or severe renaldysfunction, acute coronary syndrome, pulmonary embolism, or a history ofcongestive heart failure as they may influence NT-proBNP values. Blood wasobtained and NT-proBNP determined using the Response Biomedical RAMPplatform technology. A NT-proBNP of 250 ng/L was used as a cutoff. Leftventricular dysfunction was defined as the presence of any hypertrophy. Descriptivestatistics are used to report diagnostic performance. Area under the curve (AUC)analysis is performed to identify ideal NT-proBNP value.

Results: Forty-nine patients were enrolled with a mean age of 58 yo. Twenty-fourpercent of these patients were not being treated for hypertension. The AUC was 0.67(CI 95 0.52–0.80). The best diagnostic performance occurred when NT-proBNP

Research Forum Abstracts

S54 Annals of Emergency Medicine Volume , . : September