Objectives. To assess the impact of a scribe program on an academic, tertiary care facility. Methods. A retrospective analysis of emergency department (ED) data, prior to and after scribe program implementation, was used to quantitatively assess the impact of the scribe program on measures of ED throughput. An electronic survey was distributed to all emergency medicine residents and advanced practice providers to qualitatively assess the impact of the scribe program on providers. Results. Several throughput time measures were significantly lower in the postscribe group, compared to prescribe implementation, including time to disposition. The left without being seen (LWBS) decrease was not statistically significant. A total of 30 providers responded to the survey. 100&#x25; of providers indicated scribes are a valuable addition to the department and they enjoy working with scribes. 90&#x25; of providers indicated scribes increase their workplace satisfaction and quality of life. Conclusions. Through evaluation of prescribe and postscribe implementation, the postscribe time period reflects many throughput improvements not present before scribes began. Scribe Program implementation led to improved ED throughput for discharged patients with further system-wide challenges needing to be addressed for admitted patients.

Brandon Allen

Ben Banapoor

Emily C. Weeks

Thomas Payton

An Assessment of Emergency Department Throughput and Provider Satisfaction after the Implementation of a Scribe Program

Objectives. The time emergency department (ED) patients spend from presentation to admittance is known as their length of stay (LOS). This study aimed to quantify the inpatient occupancy rate (InptOcc)/ED LOS relationship and develop a methodology for identifying resource-allocation triggers using InptOcc-LOS association-curve inflection points. Methods. This study was conducted over 200 consecutive days at a 700-bed hospital with an annual ED census of approximately 50,000 using multivariate spline (piecewise) regression to model the InptOcc/LOS relationship while adjusting for confounding covariates. Nonlinear modeling was used to assess for InptOcc/LOS associations and determine the inflection point where InptOcc profoundly impacted LOS. Results. At lower InptOcc, there was no association. Once InptOcc reached &#x2265;88&#x25;, there was a strong InptOcc/LOS association; each 1&#x25; InptOcc increase predicted a 16-minute (95&#x25; CI, 12&#x2013;20 minutes) LOS prolongation, while the confounder-adjusted analysis showed each 1&#x25; InptOcc increase &#x3e;89&#x25; precipitating a 13-minute (95&#x25; CI, 10&#x2013;16 minutes) LOS prolongation. Conclusions. The study hospital&#x2019;s InptOcc was a significant predictor of prolonged ED LOS beyond the identified inflection point. Spline regression analysis identified a clear inflection point in the InptOcc-LOS curve that potentially identified a point at which to optimize inpatient bed availability to prevent increased costs of prolonged LOS.

Lori Whelan

Boyd Burns

Michael Brantley

Tyler Haas

Annette O. Arthur

Stephen H. Thomas

Mathematical Modeling of the Impact of Hospital Occupancy: When Do Dwindling Hospital Beds Cause ED Gridlock?

Aim. The aim of this study was to carry out an audit of healthcare plans in New Zealand and Oman. Methods. The study utilizes a deductive content analysis method. Written plans from New Zealand District Health Boards (DHBs) and the Omani secondary and tertiary hospitals were analyzed. A checklist was used to score the plans against twelve elements which are command and control, hazard analysis, surge capability, communication, standard operating procedures (SOPs), life-line backups, public and media, training, welfare, coordination, and recovery. Results. There were 14 plans from New Zealand and 7 plans from Oman analysed. The overall coverage of New Zealand plans was 67.5&#x25; compared to 53.3&#x25; in Oman. Plans from both countries scored similarly in &#x201C;command and control,&#x201D; &#x201C;hazard analysis,&#x201D; &#x201C;surge,&#x201D; and &#x201C;communication&#x201D; elements. Omani plans scored lower than those of New Zealand in &#x201C;media and the publicv&#x201D; &#x201C;training,&#x201D; &#x201C;coordination,&#x201D; and &#x201C;recovery.&#x201D; Both countries scored very low in addressing the welfare of responders. Conclusion. This study highlighted the value of health emergency plans in New Zealand as reflected by the high score of DHBs&#x2019; coordination. Therefore, a similar approach in Oman will enhance emergency preparedness. Responders&#x2019; welfare is an issue that needs to be addressed by emergency preparedness plans in both countries.

Sultan Al-Shaqsi

Robin Gauld

David McBride

Ammar Al-Kashmiri

Abdullah Al-Harthy

The State of Healthcare Disaster Plans in New Zealand and the Sultanate of Oman: An International Comparative Analysis

Objectives. We sought to validate and refine a decision rule for chest X-ray (CXR) utilization in nontraumatic chest pain (CP) patients presenting to the emergency department (ED). Methods. Retrospective review of ED patients presenting with CP who had CXR performed during three nonconsecutive months was performed. The presence of 18 variables derived from history and exam was ascertained. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the original rule were calculated. Refinement using additional variables was performed. Results. 967 patient charts were reviewed. 89.9&#x25; of CXR were normal, 5.2&#x25; had insignificant findings, and 5.1&#x25; had significant findings. Application of the criteria had a sensitivity/specificity of 74&#x25;/59&#x25; and a PPV/ NPV of 9&#x25;/98&#x25;. Rule modification to obtain CXR for age &#x2265; 65 years, history of congestive heart failure and alcohol abuse, and exam findings of decreased breath sounds, fever, and tachypnea maintained sensitivity while improving specificity to 69&#x25;. Conclusions. Most CP patients have normal CXRs. Narrowing a decision rule to obtain CXR in patients with age &#x2265; 65 years, history of congestive heart failure and alcohol abuse, and exam findings of decreased breath sounds, fever, and tachypnea maintain sensitivity while improving specificity and NPV.

Case Newsom

Rebecca Jeanmonod

Karl Weller

Nabil Boutros

Mark Reiter

Donald Jeanmonod

Validation of a Decision Rule and Derivation of a Modified Rule to Obtain Chest Radiograph in Patients with Nontraumatic Chest Pain in the Emergency Department

Objective. To determine the common presenting problems for young people attending the emergency department. Design. A retrospective review of electronic patient records of all young people between the ages of 13 and 17 who attended a UK University Hospital ED between 07/02/2007 and 06/02/2008 (<svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-0.1560001pt" id="M1" height="8.41101pt" version="1.1" viewBox="0 -8.25501 52.9555 8.41101" width="52.9555pt"><g transform="matrix(.013,0,0,-0.013,0,0)"><path id="g50-111" d="M504 89L488 119C453 85 428 69 416 69C408 69 405 75 412 102L462 304C492 438 460 451 436 451S388 441 356 423C311 397 229 336 170 256H168L189 340C208 418 200 451 177 451C144 451 82 413 24 352L40 322C65 345 98 369 108 369C114 369 119 363 112 335L28 -3L36 -12C54 -3 83 4 112 10C125 73 138 122 153 174C205 258 328 382 376 382C395 382 399 369 384 305L330 93C312 25 323 -12 351 -12C378 -12 439 21 504 89Z"/></g><g transform="matrix(.013,0,0,-0.013,10.332,0)"><path id="g54-34" d="M556 331V384H55V331H556ZM556 140V193H55V140H556Z"/></g><g transform="matrix(.013,0,0,-0.013,21.95,0)"><path id="g50-50" d="M389 0V32C297 38 291 46 291 118V635C234 613 175 595 109 583V556L161 554C203 552 207 547 207 497V118C207 46 201 38 110 32V0H389Z"/></g><g transform="matrix(.013,0,0,-0.013,28.281,0)"><path id="g50-49" d="M245 635C92 635 37 457 37 312C37 149 91 -12 244 -12C395 -12 449 166 449 312C449 469 395 635 245 635ZM243 598C332 598 358 454 358 312C358 173 334 26 245 26C158 26 128 174 128 313S152 598 243 598Z"/></g><g transform="matrix(.013,0,0,-0.013,34.612,0)"><path id="g50-53" d="M462 177V227H365V632H320C217 496 116 350 21 208V177H284V109C284 43 280 38 190 31V0H451V31C369 38 365 43 365 108V177H462ZM284 227H88C155 336 218 430 282 519H284V227Z"/></g><g transform="matrix(.013,0,0,-0.013,40.943,0)"><path id="g50-54" d="M158 548H390L417 615L410 623H122L83 318C105 326 143 337 185 337C296 337 350 275 350 188C350 116 308 42 225 42C164 42 122 74 100 93C90 101 82 99 72 92C60 82 51 68 50 59C48 46 52 38 66 24C82 9 125 -12 172 -12C225 -11 292 15 346 59C408 108 437 166 437 226C437 309 371 397 242 397C214 397 170 382 133 369L158 548Z"/></g><g transform="matrix(.013,0,0,-0.013,47.274,0)"><use xlink:href="#g50-54"/></g></svg>). Results. All emergency department attendances for young people over a one-year period were studied in order to determine the common presenting problems. There were a total of 10455 attendances by 8303 young people. The presenting problem in 7505 (71.8&#x25;) was classified as injury. Of the remainder the commonest presenting problems reported for young people were abdominal pain (480, 16.3&#x25;), self-harm (314, 10.6&#x25;), fits, faints and funny turns (308, 10.4&#x25;), breathing difficulty (213, 7.2&#x25;), and intoxication (178, 6.0&#x25;). Ten presenting problems accounted for 72&#x25; of noninjury related attendances. Conclusions. Clinical guidelines and pathways developed for young people attending the emergency department should target the commonest presenting problems. In our cohort ten presenting problems account for almost three-quarters of all noninjury attendances for young people. The presenting problems are different to those described in younger children in previous studies. These results will inform the development of clinical pathways in order to improve emergency care.

Dhurgshaarna Shanmugavadivel

Rebecca Sands

Damian Wood

Common Presenting Problems for Young People Attending the Emergency Department

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Advances in Emergency Medicine