SHM Converge Scientific Abstract ePoster Gallery-Systemwide Level Loading as a Strategy to Reduce Emergency Department Boarding and Improve Hospital Capacity Management.

Pdf Summary

This poster examines whether level loading (LL), supported by a clinical expeditor (CE), improves emergency department (ED) and hospital throughput at INTEGRIS Health Baptist Medical Center, a tertiary care hospital in Oklahoma City.

<strong>Background:</strong> ED crowding can cause prolonged boarding, delayed admissions, and inefficiency. LL aims to balance patient volume across hospitals in a system so no single site becomes overloaded.

<strong>Methods:</strong> The authors performed a retrospective before-and-after analysis of key hospital performance metrics following implementation of LL with a CE. Metrics compared included: percentage of patients staying in the ED more than 2 hours after an admission decision, percentage of admitted patients with ED stays over 280 minutes, mean time from admission order to ED departure, total ED length of stay (LOS) for admitted patients, transfer refusal rates, and case mix index (CMI). Statistical analysis was performed in SPSS, with p ≤ 0.05 considered significant.

<strong>Results:</strong> After LL implementation, the hospital saw:
- A 7.6% decrease in patients remaining in the ED longer than 2 hours after admission decision.
- A 7.1% decrease in admitted patients with ED stays exceeding 280 minutes.
- A 38.5-minute reduction in mean time from admission order to ED departure.
- A 38.5-minute reduction in total ED LOS for admitted patients.
- A significant drop in transfer refusals from 131 to 84 per month.
- A positive, though not statistically significant, increase in CMI from 2.34 to 2.43.

<strong>Conclusion:</strong> LL with a CE significantly improved ED throughput and hospital capacity management, reducing boarding times and length of stay while also lowering transfer refusals. The rise in CMI suggests the hospital may have been able to care for higher-acuity patients, potentially improving reimbursement.

Asset Subtitle

Ahmed Ali Aziz

Meta Tag

Author List Ahmed Ali Aziz, Babak Allahyar, Chelsey Gilbertson, FNU Rabel, Jason Hall, Jonathan Schmitz, Kimberly Williams, Mobolaji Olulade, Tina Malone

Category Research

Category Innovations

Concept Level-Loading

Concept Emergency Department Boarding Time

Concept Emergency Department Length of Stay

Concept Clinical Expeditor

Concept Patient Flow

Distinguished Non-Finalist

Presenter Organization INTEGRIS Health Baptist Medical Center, Oklahoma City, Oklahoma & Oklahoma State University College of Osteopathic Medicine, Stillwater, Oklahoma

Presenting Author Ahmed Ali Aziz

Track Quality Improvement

Keywords

level loading

clinical expeditor

emergency department throughput

hospital throughput

ED crowding

boarding time

length of stay

transfer refusals

admission decision

case mix index

Level-Loading

Emergency Department Boarding Time

Emergency Department Length of Stay

Clinical Expeditor

Patient Flow