Evidence Based Care in the ED

In this Children’s ED, 7500 patient days in the ED were because of 4 of the most common issues. There was a desire to see if adopting evidence based best practices would improve outcomes

Case Study Details

  • 30% Reduction in admissions for the common illnesses
  • 50% drop in in-patient days
  • 25% drop in length of stay
  • 10 beds saved per year
  • 830 additional patients can be supported with the savings

Interventions aimed at reducing ED admissions, Length of Stay and Clinical Outcomes were developed from published best practices and the institution’s internal observations and thoughts

  • Developed process and procedures built around evidence based best practices, teamwork, and communications
  • Used simulation to provide deliberate practice of these skills in simulated high risk, time pressured critical environments
  • IRB granted exempt status, obtained confidentiality and video consent from all participants
  • Participants required to participate in simulaton but were not required to complete aptitude or knowledge surveys

2 days of non-clinical duty for each learner

  • additional faculty time to develop curriculum
  • additional cost to support simulation training for staff

< 1 year (2007)

Clinical resources to review best practices literature and adjust for internal constraints

  • space to conduct simulation training
  • properly trained faculty to support training initiative
  • learner time to train away from clinical duties

7500 patient days in the ED due to 4 of the most common issues

  • based off of a 450 bed hospital
  • based off of an admission rate of 28,000 per year
  • 50% admissions through main hospital
  • 50% admission through satellite OPS centers
  • Continued in-efficiency in managing patients with the 4 most common issues
  • Poor management of resources for care being provided to patients
  • reduced capacity by 830 patients due to inefficiencies
  • loss of potential revenue from the 830 prospective patients, ~ $28.68 million/year

Decision Maker Talking Points

  • Be able to treat an additional 830 patients per year in the ED
  • Potential Revenue of an additional $28.68 million/year for the ED alone
  • Better patient care for community, be able to serve more people with same resources
  • If we implement program, for community PR show advocacy for Patient Safety, blowing past national average
  • can be part of any number of patient safety movements, also good for PR
  • Potential Revenue of an additional $28.68 million/year for the ED alone
  • Be able to treat an additional 830 patients per year in the ED
  • 25% drop in length of stay of patients with the one of the 4 common issues
  • cost of learners is 2 days of simulation and training/year
  • Be able to treat an additional 830 patients per year in the ED
  • 25% drop in length of stay of patients with the one of the 4 common issues
  • better clinical outcomes for same patient demographic with the common illnesses
  • can be part of any number of patient safety movements, also good for PR
  • need to train medical students with evidence based best practices
  • need to have medical students training in an IPE environment to best prepare for current needs in Hospitals
  • have students prepared to operate in high risk, time pressured critical environments
  • better preparing the medical students given limitations on clinical hours
  • practicing in a simulated environment instead of on actual patients
  • need to train nursing students with evidence based best practices
  • need to have nursing students training in an IPE environment to best prepare for current needs in Hospitals
  • have students prepared to operate in high risk, time pressured critical environments
  • better preparing the nursing students given limitations access to clinical placements
  • practicing in a simulated environment instead of on actual patients
  • Better efficiency in the care of patients with the most common problems
  • increase the ability of staff to treat more patients
  • ability to retain staffing by showing value for patient safety
  • higher retention of learning through deliberate practice in team environments
  • ability to better adjust behavior as teams train together
  • making the case will involve a fully engaged staff of passionate educators
  • make clear that faculty educators must be trained to conduct deliberate practice and feedback
  • support a part of the institutions patient safey initiative to align with mission focus
  • focus on capturing the appropriate ROI metrics for you environment