Impact of a logistics management program on admitted patient boarders within an emergency department.

INTRODUCTION: ED crowding is a public health issue, and hospitals across the country must pursue aggressive strategies to improve patient flow to help solve this growing problem. The logistics management program (LMP) is an expansion of the bed management process to include a systematic approach to patient flow management throughout the facility and a clinical liaison or field agent to drive throughput at all points of care. The purpose of this study was to examine the effects of an LMP on ED length of stay (ED evaluation times and ED placement times), as well as inpatient length of stay (IPLOS). METHODS: This is a quasi-experimental study of 28,684 ED admissions in a suburban, tertiary medical center before and after implementing an LMP (2008 vs 2009). RESULTS: The median ED evaluation time was 219 minutes (interquartile range [IQR], 178 minutes) in 2008 versus 207 minutes (IQR, 171 minutes) in 2009 (P < .001). The median ED placement time was 219 minutes (IQR, 259 minutes) in 2008 versus 193 minutes (IQR, 158 minutes) in 2009 (P < .001). The median IPLOS was 3.93 days (IQR, 4.9 days) in 2008 versus 3.83 days (IQR, 4.7 days) in 2009 (P < .001), which represents a reduction of 1,483 inpatient days in 2009. DISCUSSION: The results provide strong evidence to support the impact of an LMP on decreasing ED evaluation times, ED placement times, and IPLOS. Further exploration is needed to examine the program as a best practice, as well as its applicability for other facilities.

Examining the impact of mental illness and substance use on recidivism in a county jail.

This paper describes the recidivism patterns over a 4 year period for a cohort of people admitted to a large US urban jail system in 2003 and analyzes how these patterns vary based on presence of mental illness and substance abuse. Jail detention and behavioral health service records were merged for all admissions to a large urban jail system in 2003 (N=24,290). Descriptive statistics were used to analyze the recidivism patterns for people admitted to jail in 2003 (N=20,112) over a four year period. Recidivism patterns of people without mental illness or substance use disorders were compared with people with serious mental illness, substance abuse disorders, and dual diagnoses. These analyses found that over half of the people who returned to jail during the 4 year follow-up period did so in the first year. This finding did not differ by any diagnostic category. Analysis of the number of people readmitted to the jail found that people who had a diagnosis of mental illness alone had the lowest number of readmissions to jail in the 4 years after release with 50% having at least one readmission after their initial release. People with dual diagnoses, in contrast, had the highest number of readmissions to jail during the study time frame, with 68% having at least one readmission during the 4 years after release. Substance use is a driving force behind the recidivism of people with mental illness leaving a US urban jail. These findings illustrate the importance of developing interventions that provide timely access to intensive co-occurring substance abuse and mental health treatment during the immediate period after release that are capable of addressing both individual and environment factors that promote the return to drug use after release.