The impact of the improvement in internal medicine consultation process on ED length of stay

Introduction: Although consultations are essential for delivering safe, high-quality care to patients in emergency departments, they contribute to emergency department patient flow problems and overcrowding which is associated with several adverse outcomes, such as increases in patient mortality and poor quality care. This study aimed to investigate how time flow metrics including emergency department length of stay is influenced by changes to the internal medicine consultation policy. Method: This study is a pre- and post-controlled interventional study. We attempted to improve the internal medicine consultation process to be more concise. After the intervention, only attending emergency physicians consult internal medicine chief residents, clinical fellows, or junior staff of each internal medicine subspecialty who were on duty when patients required special care or an admission to internal medicine. Results: Emergency department length of stay of patients admitted to the department of internal medicine prior to and after the intervention decreased from 996.94 min to 706.62 min. The times from consultation order to admission order and admission order to emergency department departure prior to and after the intervention were decreased from 359.59 min to 180.38 min and from 481.89 min to 362.37 min, respectively. The inpatient mortality rates and Inpatient bed occupancy rates prior to and after the intervention were similar. Conclusion: The improvements in the internal medicine consultation process affected the flow time metrics. Therefore, more comprehensive and cooperative strategies need to be developed to reduce the time cycle metrics and overcrowding of all patients in the emergency department. (C) 2017 Elsevier Inc. All rights reserved.