{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T15:28:11Z","timestamp":1781105291616,"version":"3.54.1"},"reference-count":0,"publisher":"California Digital Library (CDL)","issue":"5","license":[{"start":{"date-parts":[[2024,8,1]],"date-time":"2024-08-01T00:00:00Z","timestamp":1722470400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Western Journal of Emergency Medicine"],"abstract":"<p>Objective: Because admitted emergency department (ED) patients waiting for an inpatient bed contribute to dangerous ED crowding, we conducted a patient \ufb02ow investigation to discover and solve out\ufb02ow delays. After solution implementation, we measured whether the time admitted ED patients waited to leave the ED was reduced. Methods: In June 2022, a team using Lean Healthcare methodologies identi\ufb01ed \ufb02ow delays and underlying barriers in a Midwest, mid-sized hospital. We calculated barriers\u2019 magnitudes of burden by the frequency of involvement in delays. During October\u2013December 2022, solutions targeting barriers were implemented. In October 2023, we tested whether waiting time, de\ufb01ned as daily median time in minutes from admission disposition to departure (ADtoD), declined by conducting independent sample, single-tailed t-test comparing pre- to post-intervention time periods, January 1\u2013September 30, 2022 (273 days) to January 1\u2013September 30, 2023 (273 days). Additionally, we regressed ADtoD onto pre-\/post period while controlling for ED volume (total daily admissions and ED daily encounters) and hospital occupancy. A run chart analysis of monthly median ADtoD assessed improvement sustainability. Results: Process mapping revealed that three departments (ED, environmental services [EVS], and transport services) co-produced the out\ufb02ow of admitted ED patients wherein 18 delays were identi\ufb01ed. The EVS-clinical care collaboration failures explained 61% (11\/18) of delays. Technology contributed to 78% (14\/18) of delays primarily because staff\u2019s technology did not display needed information, a condition we coined \u201cdigital blindness.\u201d Comparing pre- and post-intervention days (3,144 patients admitted pre-intervention and 3,256 patients post), the median minutes a patient waited (ADtoD) signi\ufb01cantly decreased (96.4 to 87.1 minutes, P = 0.04), even while daily ED encounter volume signi\ufb01cantly increased (110.7 to 117.3 encounters per day, P &amp;lt; 0.001). After controlling in regression for other factors associated with waiting, the intervention reduced ADtoD by 12.7 minutes per patient (standard error 5.10, P = 0.01; 95% con\ufb01dence interval \u221222.7, \u22122.7). We estimate that the intervention translated to ED staff avoiding 689 hours of admitted patient boarding over nine months (ADtoD coef\ufb01cient [\u221212.7 minutes] multiplied by post-intervention ED admissions [3,256] and divided by 60). Run chart analysis substantiated the intervention\u2019s sustainability over nine months. Conclusion: After systemwide patient \ufb02ow investigation, solutions resolving digital blindness and environmental services-clinical care collaboration failures signi\ufb01cantly reduced ED admitted patient boarding. <\/p>","DOI":"10.5811\/westjem.18626","type":"journal-article","created":{"date-parts":[[2024,8,1]],"date-time":"2024-08-01T15:35:01Z","timestamp":1722526501000},"source":"Crossref","is-referenced-by-count":4,"title":["Reduced Time to Admit Emergency Department Patients to Inpatient Beds Using Outflow Barrier Analysis and Process Improvement"],"prefix":"10.5811","volume":"25","author":[{"given":"Marjorie A.","family":"Erdmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ipe S.","family":"Paramel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cari","family":"Marshall","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karissa","family":"LeHew","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abigail","family":"Kee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Soliman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica","family":"Vuong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sydney","family":"Spillane","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua","family":"Baer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shania","family":"Do","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiffany","family":"Jones","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Derek","family":"McGuire","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"29705","published-online":{"date-parts":[[2024,8,1]]},"container-title":["Western Journal of Emergency Medicine"],"original-title":[],"link":[{"URL":"https:\/\/escholarship.org\/content\/qt3j1829kp\/qt3j1829kp.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2024,9,18]],"date-time":"2024-09-18T19:38:16Z","timestamp":1726688296000},"score":1,"resource":{"primary":{"URL":"https:\/\/escholarship.org\/uc\/item\/3j1829kp"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,1]]},"references-count":0,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2024,9,18]]}},"URL":"https:\/\/doi.org\/10.5811\/westjem.18626","relation":{},"ISSN":["1936-9018"],"issn-type":[{"value":"1936-9018","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,8,1]]}}}