Int J Med Inform - Effects of a short text message reminder system on emergency department length of stay.

Tópicos

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Resumo

RPOSE: Specialty consultations and waiting for admission to a hospital bed are major contributors to increased length of stay and overcrowding in the emergency department. We implemented a computerized short messaging service to inform care providers of patient delay in order to reduce length of stay. The purpose of this study was to evaluate the effects of this strategy on length of stay in the emergency department.METHODS: This was a before-and-after observational study. Prior to this study, we registered the mobile phone numbers of all board certified specialists into a computerized physician order entry database and developed an auto-sending short messaging program linked to consultation orders. The short message was transmitted at 2 and 4h after consultation, when a disposition was not yet established, and at 8h after the admission order if the patient was still waiting. The length of stay of consulted patients and intervals such as consultation time (registration-consultation), disposition time (consultation-admission decision), and boarding time (admission decision-hospitalization) of admitted patients were compared between the pre-implementation (September 2009) and post-implementation period (November 2009). Subgroup analyses of disposition time were performed according to time of consultation and the number of consultations.RESULTS: A total of 7518 patients visited the emergency department during the pre-periods and post-periods. Among them, 3335 patients required specialty consultations. The median length of stay of consulted patients decreased significantly after implementation of the messaging system (pre-207 min vs. post-193 min, p<0.001). Among admitted patients, the median length of stay decreased by 36 min from 294 min to 258 min (p<0.001). In the subgroup analysis, times for establishing patient dispositions decreased significantly when the consultation was performed at night and when there was only one department consulted. The numbers of patients with disposition times within 2 and 4h and boarding times within 8h were all increased after implementation of the short message service program.CONCLUSIONS: This study suggested that the computerized physician order entry-based short messaging service program, used to inform decision-makers of patient delay, could reduce the length of stay for consulted patients in the emergency department.

Resumo Limpo

rpose specialti consult wait admiss hospit bed major contributor increas length stay overcrowd emerg depart implement computer short messag servic inform care provid patient delay order reduc length stay purpos studi evalu effect strategi length stay emerg departmentmethod beforeandaft observ studi prior studi regist mobil phone number board certifi specialist computer physician order entri databas develop autosend short messag program link consult order short messag transmit h consult disposit yet establish h admiss order patient still wait length stay consult patient interv consult time registrationconsult disposit time consultationadmiss decis board time admiss decisionhospit admit patient compar preimplement septemb postimplement period novemb subgroup analys disposit time perform accord time consult number consultationsresult total patient visit emerg depart preperiod postperiod among patient requir specialti consult median length stay consult patient decreas signific implement messag system pre min vs post min p among admit patient median length stay decreas min min min p subgroup analysi time establish patient disposit decreas signific consult perform night one depart consult number patient disposit time within h board time within h increas implement short messag servic programconclus studi suggest computer physician order entrybas short messag servic program use inform decisionmak patient delay reduc length stay consult patient emerg depart

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