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Objective Improve left without being seen (LWBS) in our high volume, tertiary care trauma center. Prior to intervention, our LWBS rate was 4.4%. Including a direct bedding strategy, we successfully reduced our LWBS to <1%. Design and method We utilized a retrospective before and after model. We hired a clinical documentation specialist and tracked several metrics. These included daily census, admission rates, and door to provider, door to room, average boarding, and door to disposition times. Data were collected and disseminated daily. Reports were shared at organization quality meetings. Simultaneously, we implemented the direct bedding initiative in conjunction with quick registration. To accommodate higher numbers of patients and expediate movement to care spaces, all patient spaces were clearly designated and labeled. Results Direct bedding began in September 2015 and our LWBS was 4.4%. One-year post-intervention, our LWBS was <2%. Within four years, it was <0.5%. The LWBS rate for each year, 2016 to 2019, was significantly lower than the control period (p < 0.01) (2015 up to September). Improvement was also seen in door-to-provider time and with patient experience scores. Conclusion Our multifactorial approach was associated with a profound and sustained reduction in LWBS over a short time period.
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Burnout is a complex syndrome thought to result from long-term exposure to career-related stressors. Physicians are at higher risk for burnout than the general United States (US) working population, and emergency medicine has some of the highest burnout rates of any medical specialty. Burnout impacts physicians' quality of life, but it can also increase medical errors and negatively affect patient safety. Several studies have reported lower burnout rates and higher job satisfaction in academic medicine as compared with private practice. However, researchers have only begun to explore the factors that underlie this protective effect. This paper aims to review existing literature to identify specific aspects of academic practice in emergency medicine that may be associated with lower physician burnout rates and greater career satisfaction. Broadly, it appears that spending time in the area of emergency medicine one finds most meaningful has been associated with reduced physician burnout. Certain non-clinical academic work, including involvement in research, leadership, teaching, and mentorship, have been identified as specific activities that may protect against burnout and contribute to higher job satisfaction. Given the epidemic of physician burnout, hospitals and practice groups have a responsibility to address burnout, both by prevention and by early recognition and support. We discuss methods by which organizations can actively foster physician well-being and provide examples of 2 leading academic institutions that have developed comprehensive programs to promote physician wellness and prevent burnout.
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OBJECTIVE: To describe the current state of emergency departments in Connecticut. METHODS: We analyzed Connecticut data from the National Emergency Department Inventory - Nev England survey. We categorized emergency departments (EDs) into high-volume (> 50 000 annual vis its) vs low-volume (< 50000 visits). RESULTS: 31 (89%) Connecticut EDs responded. The median annual ED visit volume was 45,000 visits with 20 (65%) EDs reported being "at or over capacity," including nearly all high-volume EDs. Only 1: (35%) EDs had pediatric emergency care coordinators, and access to specialties varied with notable shortages in neurology, neurosurgery, plastic sur- gery, and hand surgery. Electronic health records had near universal adoption but video consultation utilization was limited. Computer tomography and point-of-care ultrasound was widely available. CONCLUSION: While Connecticut EDs reported the ability to provide a broad array of emergency care services, policymakers seeking to improve acute care access should focus efforts on crowding and pediatric emergency care, as well as video consultation adoption.
