Clinical trial NCT03943810: Analysis and Improvising Working Practices in the ER
Official title: Characterizing ER Activities for Failure Prevention
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: EMERGENCY MEDICINE
Lead sponsor: Sheba Medical Center
Sponsor class: OTHER_GOV
Collaborators: name: Dr. Yahel Giat
name: Pr. Merav Lidar
name: Dr. Michael Dreyfuss
name: Dr. Avinoah Irony
name: Dr. Gabrieal Breuer
First posted: 2019-05-09
Enrollment: 500000
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Observational model: COHORT
Time perspective: RETROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: All the patients admitted to the adult primary SMC ED ED between August 2014 and December 2017.

. The data here did not include other EDs located elsewhere in SMC, (e.g., pediatric ED, gynecology ED, ophthalmology ED and psychiatric ED).

Brief summary: Analysis of electronic files of patients presenting to the emergency department to improve current practice

Detailed description: Overcrowding in the emergency department (ED) is a pressing healthcare issue globally and has been shown to negatively affect the quality of treatment, clinical outcomes and patient satisfaction.

In recent years, an increasing number of studies have tried to implement changes in the ED to increase efficiency and thereby reduce the length of stay (LOS). Examples to these efforts include physician triage, expanding the nursing scope of practice and patient-flow design (e.g., creating fast track units) in the ED. Importantly, not all intuitive changes in the ED resulted in the reduction of LOS Therefore, implementing changes in the ED must be done with caution and preceded with a cost-benefit analysis of the effects of the intervention using available retrospective data.

This research was conducted in the ED of Sheba Medical Center (SMC), a tertiary government-owned hospital in Israel with 1400 beds. This study is a retrospective medical record review of patients admitted to the adult primary SMC ED. The study sample comprises all the walk-in patients that visited the ED between January 2013 and December 2017. The data here does not include other EDs located elsewhere in SMC, (e.g., pediatric ED, gynecology ED, ophthalmology ED, and psychiatric ED). All admissions files in SMC ED are recorded in a computerized system with negligible exceptions (such as power outage and connection or server maintenance). The time and date of every change in the electronic files are also recorded in the system. Therefore, it is possible to track the waiting times as well as the full content of the admission file.

The aim of this study is to identify and analyze potential modifications in current ED practice which may improve outcomes such as LOS, missed diagnosis, leaving without being seen, patient satisfaction, etc.

Eligibility criteria: Inclusion Criteria:

* all the patients that visited the SMC - ED between August 2014 and December 2017

Exclusion Criteria:

* patients in which the electronic file is absent

Primary outcomes:
measure: Length of stay
timeFrame: Starting from January1st 2014 until January 30th 2018
measure: left without being seen
timeFrame: Starting from January1st 2014 until January 30th 2018
measure: missed diagnosis
timeFrame: Starting from January1st 2014 until January 30th 2018
measure: physician mistakes
timeFrame: Starting from January1st 2014 until January 30th 2018
measure: Admission to hospital
timeFrame: Starting from January1st 2014 until January 30th 2018
measure: return to ED after discharge
timeFrame: Starting from January1st 2014 until January 30th 2018
measure: Time till being seen by a physician
timeFrame: Starting from January1st 2014 until January 30th 2018
Secondary outcomes:
Other outcomes:
Locations:
Study officials:
References: