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Title: Impact of inpatient Care in Emergency Department on outcomes: a quasi-experimental cohort study
Authors: Lateef, A 
Lee, S.H
Fisher, D.A 
Goh, W.-P
Han, H.F
Segara, U.C
Sim, T.B 
Mahadehvan, M
Goh, K.T
Cheah, N
Lim, A.Y 
Phan, P.H 
Merchant, R.A 
Keywords: aged
case control study
health care delivery
hospital admission
hospital bed utilization
hospital emergency service
hospital patient
length of stay
middle aged
organization and management
retrospective study
statistics and numerical data
tertiary care center
treatment outcome
very elderly
Aged, 80 and over
Bed Occupancy
Case-Control Studies
Delivery of Health Care
Emergency Service, Hospital
Length of Stay
Middle Aged
Patient Admission
Retrospective Studies
Tertiary Care Centers
Treatment Outcome
Issue Date: 2017
Citation: Lateef, A, Lee, S.H, Fisher, D.A, Goh, W.-P, Han, H.F, Segara, U.C, Sim, T.B, Mahadehvan, M, Goh, K.T, Cheah, N, Lim, A.Y, Phan, P.H, Merchant, R.A (2017). Impact of inpatient Care in Emergency Department on outcomes: a quasi-experimental cohort study. BMC health services research 17 (1) : 555. ScholarBank@NUS Repository.
Rights: Attribution 4.0 International
Abstract: BACKGROUND: Hospitals around the world are faced with the issue of boarders in emergency department (ED), patients marked for admission but with no available inpatient bed. Boarder status is known to be associated with delayed inpatient care and suboptimal outcomes. A new care delivery system was developed in our institution where boarders received full inpatient care from a designated medical team, acute medical team (AMT), while still residing at ED. The current study examines the impact of this AMT intervention on patient outcomes.METHODS: We conducted a retrospective quasi-experimental cohort study to analyze outcomes between the AMT intervention and conventional care in a 1250-bed acute care tertiary academic hospital in Singapore. Study participants included patients who received care from the AMT, a matched cohort of patients admitted directly to inpatient wards (non-AMT) and a sample of patients prior to the intervention (pre-AMT group). Primary outcomes were length of hospital stay (LOS), early discharges (within 24 h) and bed placement. Secondary outcomes included unplanned readmissions within 3 months, and patient's bill size. χ2- and Mann-Whitney U tests were used to test for differences between the cohorts on dichotomous and continuous variables respectively.RESULTS: The sample comprised of 2279 patients (1092 in AMT, 1027 in non-AMT, and 160 in pre-AMT groups). Higher rates of early discharge (without significant differences in the readmission rates) and shorter LOS were noted for the AMT patients. They were also more likely to be admitted into a ward allocated to their discipline and had lower bill size compared to non AMT patients.CONCLUSIONS: The AMT intervention improved patient outcomes and resource utilization. This model was noted to be sustainable and provides a potential solution for hospitals' ED boarders who face a gap in inpatient care during their crucial first few hours of admissions while waiting for an inpatient bed.
Source Title: BMC health services research
ISSN: 14726963
DOI: 10.1186/s12913-017-2491-x
Rights: Attribution 4.0 International
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