Abstract 257: Cutting Down the Lag- an Assessment of the Delay in the House Staff’s Evaluation of an Admission
Authors: Kaplan Jason G , Kanwal Arjun , Berquist John , Eis Samuel , Zahid Rabia , Ramsay Joshua , Kher Sapna , Hatahet Ammar , Santiago-Rivera Olga 
Published: May 2020

Background:
At this institution, a delay occurs between the time the emergency department admits a patient and the admitting service’s evaluation of the patient. Since the emergency department is run on paper charting, the current system, at night, involves the emergency department writing a name and a diagnosis in the emergency department’s admission book. The night residents’ job is to admit teaching patients to the teaching service. The current system requires the night resident to physically go to the emergency department and look in the admissions book to find out about a new admission. This lack of communication can cause a great delay in evaluation of a new admission, which can be problematic. The catalyst for this study was an adverse event where a stroke was missed in the emergency department and the patient was not evaluated by the admitting service for 15 hours falling well outside the tPA window. Decreasing the delay in thorough evaluation is crucial in proper treatment of many cardiovascular conditions, which are time sensitive and can potentially prevent a catastrophic outcome.

Intervention:
Residents on the admitting service will be first asked to document their evaluation time without intervention, which will be documented with the emergency department admission time to establish a baseline. In addition to the current system of manually checking the admissions book in the emergency department, the ward clerk will page the night staff when new admissions are written in the book. Residents on the admitting service will then document their evaluation time with this new intervention, along with the emergency department admission time. The goal of this new system is to decrease the time the patient is waiting to be evaluated by the admitting service.

Results:
The mean lag time pre-intervention (N=20) was 73 minutes with a range of 0-279 minutes. Post-intervention (N=25) the mean lag time was 82 minutes with a range of 5- 337 minutes. The P-value of this study was 0.707. Residents on the admitting service were very compliant with documenting their evaluation times. Admitting residents did note the pages were inconsistent and were often missed. The rate of pages successfully sent out was not documented.

Conclusion:
The lag time before and after intervention was not found to be statistically significant. Pages were inconsistently sent out but did not impact the internal validity of the study. Since the study tested if paging the on-call residents improved the delay in evaluation, the ability to reliably send the page is as important as the response time. The paging system in this study was used as an augmentation to the current system out of some trepidation that pages could be missed and thus negatively impacting the response time. Due to the statistically insignificant data, it can be concluded that the paging system made no impact on the response time patients were seen by the admitting residents.