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Reducing hospital admissions using an interprofessional team
in an academic emergency department

SHSC-AV-Reducing Hospital admissions

Sunnybrook Health Sciences Centre (ED)

Background: Sunnybrook Emergency Department (ED) has higher admission rates compared to peer hospitals, contributing to ED crowding. This rate was higher during evening hours, when health professionals such as the geriatric nurse and social worker were not available. According to a root cause analysis, a major contributing factor to high admission rates was the lack of these health professionals and community integration. In Nov 2019, we implemented the "ED One Team" (ED1T), an interprofessional team focused on facilitating safe ED discharges with community integration, available every day from 8AM to 11PM.Within 5 months of ED1T implementation, we aimed to reduce the number of CTAS 2-5 ED patients admitted to hospital by 3 per day. S10 Canadian Journal of Emergency Medicine (2021) 23 (Suppl 1):S1-S93 1 3 Vol.:(0123456789) 

Aim statement: The primary outcome measure was the change in the number of admissions, compared to the same time period the year before ED1T. We performed a subgroup analysis for senior patients C 70 years. The process measure was the number of patients seen and discharged by ED1T. The balancing measure was the 7-day ED revisit rate for senior patients seen by ED1T compared to those not seen by ED1T. 

Measures and design: From Nov 1, 2019 to Mar 31, 2020, there were 28.6 admits/day (admit rate 19.6%). Before ED1T, there were 30.8 admits/day (19.8%). For seniors, there were 15.4 admits/day (35.0%) compared to 14.0 admits/day (35.7%) before ED1T. Admissions dropped by 2.2/day (1.4/day for seniors). The ED1T saw 987 patients in the 5 months (6.5 patients/day) with a discharge rate of 68.3%. The revisit rate for seniors was 5.9% for patients seen versus 7.1% for those not seen by ED1T. 

Evaluation/results: We reduced our admission number and rate but fell short of target. We continue to make changes via PDSA cycles to optimize the success of the ED1T. In the 5-month period, we reduced the number of admissions by 330. Assuming an average hospital length-of-stay of 5 days, 1650 potential bed-days were saved. There was not an increase in the revisit rate in those patients who were discharged by the ED1T. Emergency Departments should consider adding similar interprofessional teams to decrease hospital admissions. 

Authors: A. Verma, N. Coyle, W. Thomas-Boaz, K. Pardhan, S. Michaelson, N. Ziegler, E. Elliot, B. Ciacco, S. Shadowitz, J. Stanway, L. Fillion, A. Smith, I. Cheng

Ongoing PDSA cycles

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