Identifying and Addressing Barriers to Timely Admission from the Emergency Department to Medical/Surgical Floor

Background: Visits to Emergency Departments (ED) are increasing, which in turn increases the number of admissions from the ED to the inpatient medical/surgical floor. These increases have led to crowding in the ED, resulting in boarding of patients awaiting admission. Boarding in the ED has been linked to many adverse outcomes. In order to reduce boarding and crowding in the ED, efforts are often directed toward reducing the time from decision to admit to actual admission. The ED at a low-volume private urban medical center set a goal of 30 minutes for admission time but was not meeting this goal. The key stakeholders at a low-volume private urban medical center sought to identify the barriers to timely admission. This needs assessment project was designed to clarify the factors contributing to prolonged ED to medical/surgical floor admission. Methods: Nursing staff in the ED and medical/surgical floors were surveyed regarding their perceptions of barriers to admissions. Data was collected for one month to determine actual admission interval. Census and staffing numbers were correlated to admission times. Results: The thirteen-question survey, addressing common barriers identified in the literature, and reviewed by the project chair, showed that 86% of nursing staff were aware of the 30-minute goal for admission time. The majority of nurses (81%) identified was the overall busyness of the floor as a major perceived barrier to admissions. The mean admission interval from the ED to the medical/surgical floor was 44.9 minutes (±2 31.5). There was a statistically significant relationship between admit interval and census in the ED (r=.403, p=.027) as well as the night shift census on the medical/surgical floor (r=.406, p=.026). The Spearman correlation showed that when census in the ED increased and night shift census on the medical/surgical floor increased, admission times lengthened. Conclusions: This needs assessment project identified several important barriers to timely admissions. Results from a survey free text question found staffing, available/clean rooms, residents' orders, ED to medical/surgical floor communication, and 1:1 sitter needs as barriers to timely admissions. In the literature, similar barriers were identified. Unit census appears to be a major determinant in both the ED and on the floor when using Spearman correlation to compare admit times to census data.