Progressive prediction of hospitalisation in the emergency department: uncovering hidden patterns to improve patient flow.

INTRODUCTION: One of the factors contributing to ED crowding is the lengthy delay in transferring an admitted patient from the ED to an inpatient department (ie, boarding time). An earlier start of the admission process using an automatic hospitalisation prediction model could potentially shorten these delays and reduce crowding. METHODS: Clinical, operational and demographic data were retrospectively collected on 80 880 visits to the ED of Rambam Health Care Campus in Haifa, Israel, from January 2011 to January 2012. Using these data, a logistic regression model was developed to predict patient disposition (hospitalisation vs discharge) at three progressive time points throughout the ED visit: within the first 10 min, within an hour and within 2 hours. The algorithm was trained on 50% of the data (n=40 440) and tested on the remaining 50%. RESULTS: During the study time period, 58 197 visits ended in discharge and 22 683 in hospitalisation. Within 1 hour of presentation, our model was able to predict hospitalisation with a specificity of 90%, sensitivity of 94% and an AUCof 0.97. Early clinical decisions such as testing for calcium levels were found to be highly predictive of hospitalisations. In the Rambam ED, the use of such a prediction system would have the potential to save more than 250 patient hours per day. CONCLUSIONS: Data collected by EDs in electronic medical records can be used within a progressive modelling framework to predict patient flow and improve clinical operations. This approach relies on commonly available data and can be applied across different healthcare settings.

[INCREASED MORTALITY OF DELAYED PATIENTS IN THE EMERGENCY DEPARTMENT OF A TERTIARY MEDICAL CENTER].

INTRODUCTION: Boarding patients awaiting hospitalization in the emergency department increases mortality and complications, and stands in contrast to the recommendations of emergency medicine associations worldwide. Although Israel's Ministry of Health and the media are addressing the issue, boarding patients in emergency departments is common in hospitals throughout the country. There are no current studies that assess the influence of boarding in emergency departments on the patient's mortality and hospitalization. In 2011, a decision was made in our hospital to board patients in a separate section of the emergency department due to the lack of beds in the inpatient wards. AIMS: This study aimed to demonstrate the scale of boarding patients in a tertiary hospital in Israel and its influence on mortality and length of hospitalization. We examine effects of a deliberate boarding policy on mortality and describe the boarding phenomena, and its causes, to Israeli physicians. STUDY METHODS: This is a retrospective study, comparing patients hospitalized through the emergency department to internal medicine wards in a tertiary hospital during three consecutive years, and studying the effects of deliberate boarding policy in the emergency department on mortality and length of stay [LOS] in the hospital. RESULTS: Roughly half the patients stayed in the emergency department for more than 10 hours. The mortality of patients during the year they were deliberately boarded in a separate section in the emergency department was significantly higher than in other years, when such policy did not take place. A direct link was demonstrated between LOS in the emergency department and mortality. LOS of patients who died was significantly higher than that of patients who did not die. CONCLUSIONS: Boarding patients in the emergency department increases mortality and LOS. Ways to minimize the phenomena should be explored. DISCUSSION: For the first time, the effects of boarding patients in the emergency department in Israel are studied. The issue of boarding patients in emergency departments should be a central issue addressed by Israel's health system.

[Health hazards of energy drinks--the situation in Israel and the world].

Since 1987, with the introduction of the first commercial energy drink in Europe, the level of sale of these drinks increased rapidly throughout the western world. These drinks are based on caffeine that is found in them ndependently, and in other ingredients. Other ingredients in these drinks potentiate the effects of caffeine. Caffeine acts in the organism through inhibition and activation of various receptors, and thus affects almost all the body systems. There is an increasing body of evidence about the medical hazards of uncontrolled use of these drinks, with neurologic, psychiatric, cardiovascular and metabolic complications. There is a direct link between use of energy drinks and abuse of alcohol and drugs. Due to the above, health authorities in Israel and around the world have started addressing the regulatory, medical and informative aspects of the issue. In spite all of the above, there is lack of awareness of the public and medical teams about the hazards of cousuming these drinks.