Appropriateness of diagnosis and orientation of 996 consecutive patients admitted in an emergency department with flow-based organization.

ABSTRACT

BACKGROUND: Recent data, focused on the inability to transfer emergency patients to inpatient beds, has shown this to be the single most important factor contributing to overcrowding. Our Emergency Department (ED) was reorganized in the year 2000 based on the optimization of patients' flow. In this model, the emergency team had to refer patients to units fitting best to their condition with minimal delays. OBJECTIVES: To evaluate adequacy of both diagnosis between emergency room and hospitalization wards and patients' orientation in the context of an early discharge from the ED. METHODS: We collected data from 996 consecutive nontrauma patients for whom an admission was decided. Duration of stay in the ED and all related parameters were studied. Patients were categorized according to the adequacy of the diagnosis proposed at ED discharge as compared with the final diagnosis at hospital discharge. The patients' orientation appropriateness was also assessed. RESULTS: Despite a median duration of time of 6 h (21 min-54 h) diagnostics made by the emergency physicians and the patients' orientation were considered as adequate in most of the cases (66 and 96%, respectively). Fast track developed with medical intensive care and cardiology intensive care allowed referral of patients requiring these specific units within 2.2 h (27 min-17 h) and 2 h (41 min-8 h), respectively. The ED length of stay was highly influenced by the admission location and by the patient's age. CONCLUSION: A short time of stay in the ED is compatible with both a good diagnosis and a good orientation of ED patients requiring admission for specialized care.