the Acute Care Continuum
Is the integration of urgent, emergent, inpatient and post-discharge care of patients with acute medical conditions.
The patient population in Emergency Departments (EDs) has been steadily increasing and this trend will only rise in the years to come. The U.S. Centers for Disease Control and Prevention reports that ED visits rose 9.9% to 136 million over the calendar year in 2009 from 2008. Furthermore, factors such as population growth, the physician shortage, and hospital closures should exacerbate this patient growth in the future. As a result, there is an immediate need to increase efficiency in the ED. Quick Emergency Disposition (QED) is a program to improve ED patient throughput. It is a simple concept that has been leading to turn around times plummeting at our pilot sites. QED could also be applicable outside the ED in the Acute Care Continuum and play a role in the general movement towards efficiency in hospital integration.
QED’s first component focuses on immediate written communication needed for the next disposition. It is a process where the provider immediately documents the information needed for the next decision point so that the team can unite around the goal of moving the patient efficiently through the ED. The upshot is that the ED staff works with higher cohesion with the series of decision points that result from having a preliminary plan in writing.
As the nexus between the outpatient and inpatient care delivery systems, the Emergency Department is increasingly the gatekeeper of inpatient admissions.
Although the complexity of ambulatory care patients is increasing, the result of economic pressures on primary care physicians is a schedule that causes the older and sicker patients to receive only the same amount of physician time as the younger, healthier patients. As ambulatory care providers have less time to thoroughly assess the patient and arrange for direct admission, patients are increasingly sent to the ED. The result: now greater than half of all inpatient hospitalizations are originating in the ED.
Given this dynamic, it is not surprising that the number of ED visits has been increasing significantly. Over a recent twelve year period, visits have increased by 35%-- from 94.8 million in 1998 to 127.2 million in 2010.
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