SHM Converge Scientific Abstract ePoster Gallery-Impact of a Bed Request Order on Inpatient Arrival Time

Pdf Summary

This study examined whether adding a brief “bed request” order could speed inpatient bed assignment and reduce emergency department boarding. The intervention was introduced because, at the institution studied, admitted patients were not assigned a bed until full admission orders were placed, which may have delayed transfer from the ED.<br /><br />The team created a short bed request order that triggered bed assignment independently of full admission orders and trained hospitalists and medicine residents to use it. They compared outcomes before and after implementation using interrupted time series analysis and t-tests. The main outcomes were time from decision to admit to arrival in an inpatient bed, and time from decision to admit to bed assignment.<br /><br />Results showed no meaningful improvement after the intervention. The average number of admissions per month increased from 551.9 before the intervention to 588.2 afterward. The bed request order was used in 85.6% of cases, indicating fairly high adoption. However, overall time to arrival in an inpatient bed continued to worsen over time both before and after implementation, increasing by about 26–27 minutes per month, with no significant difference between the pre- and post-intervention trends. Similar findings were seen across acute, transitional, and intensive care patients.<br /><br />In summary, the brief bed request order did not reduce time to inpatient bed assignment or time to arrival in an inpatient bed. The authors suggest that external factors such as higher admission volume, worsening ED crowding, and staffing challenges may have overwhelmed any benefit from the workflow change. They conclude that more effective approaches are needed to reduce ED boarding and improve patient flow.

Asset Subtitle

Molly A. Kantor

Meta Tag

Author List Elizabeth Kwan, Jahan Fahimi, Maggie Jones, Molly A. Kantor

Category Research

Concept Emergency Department Crowding

Concept Emergency Department Boarding

Concept Inpatient Bed Placement

Concept Inpatient Bed Request Order

Concept Interrupted Time Series

Distinguished Non-Finalist

Presenter Organization University of California, San Francisco

Presenting Author Molly A. Kantor

Track Transitions of Care

Keywords

bed request order

inpatient bed assignment

emergency department boarding

patient flow

hospital admission

interrupted time series analysis

bed assignment delay

ED crowding

hospitalist workflow

admission orders

Emergency Department Crowding

Emergency Department Boarding

Inpatient Bed Placement

Inpatient Bed Request Order

Interrupted Time Series