Interdepartmental program to improve outcomes for acute heart failure patients seen in the Emergency Department
Implementation & Integration
TOH-17-001 The project will improve patient outcomes by ensuring that high-risk AHF cases are admitted to hospital while others are offered rapid specialist follow-up. In a recent patient safety analysis of AHF patients, we found all discharged SSO cases were preventable with the most common error (85.7%) being unsafe disposition decision. Common themes included the admitting service discharging patients, inadequate monitoring of patients post-discharge, and lack of early follow-up. This suggests that AHF patients were exposed to unnecessary risk. The project will fill an important gap in Canadian healthcare for AHF patients who need early follow-up after an ED visit in order to assess stability, review medications, order investigations, and create a long-term plan. Currently, most AHF patients cannot be seen quickly by their primary care physician and the wait for TOH clinics may be several months. TOH does not provide rapid referral clinics for AHF similar to those for other high-risk groups, e.g. chest pain or TIA. By providing rapid follow-up, we will ensure that unnecessary hospital admissions are avoided for AHF patients, who will also benefit from expert consultation regarding medication, investigations, and ongoing care.
Emergency department (ED) crowding is an important issue in the delivery of high-quality medical care. A policy was implemented to ease ED crowding by moving suitable admitted patients into inpatient hallway beds or off-service beds. This study assesses the impact of off service and hallway bed admissions on patient care and satisfaction. Retrospective and prospective data were collected from Jan 1 to Dec 31, 2011, on admissions to the oncology service via the ED. Patient care data was collected as follows: chest/abdominal exams performed at first MD visit, number of MD visits within 48 hours, time to antibiotic administration, time to complete vitals, and mean time spent in the ED. One hundred and eighteen patients were admitted to a hallway bed (HALL). A random sample of 90 patients were used for comparison in the on service (ON) and off service (OFF) groups. Among HALL patients, 4% percent discharged themselves against medical advice (0% of OFF and ON patients). MD visits within 48 hours were the same among all groups (mean=6). Time to first completion of vitals was 1:05 (hh:mm) for HALL patients (1:21 and 00:34 for OFF and ON patients, respectively). Time to antibiotic administration was 15:34 for hallway patients (23:59 and 12:35 for OFF and ON patients, respectively). More HALL patients expressed dissatisfaction with their hospital stay (16.7%) compared to OFF (0%) and ON patients (0%). Mean time for admitted patients in the ED awaiting their HALL bed was 9:14, considerably longer than for OFF patients (3:08) and ON patients (4:19).Admission of oncology patients in hallway or in offservice beds did not appear to compromise the timeliness or frequency of medical assessments. Moreover, the policy did not meet its intent to reduce patient time spent in the ED.