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Completed

NCT Number: NCT03943810

Analysis and Improvising Working Practices in the ER

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

Completed

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Key information

Conditions

Emergency Medicine

Age range

18 year and older

Sex eligibility

All sexes

Study type

Observational

About this study

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.

Who can participate

Only the study team can determine whether someone qualifies for participation.

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

Treatment and study plan

No intervention

Other

There is no intervention

Primary outcomes

  1. Length of stay

    Time frame: Starting from January1st 2014 until January 30th 2018

    The time between admitting the patient to the ED and the time of decision to release or admit to hospital

  2. left without being seen

    Time frame: Starting from January1st 2014 until January 30th 2018

    amount of patients who leave the ED without being seen by a physician

  3. missed diagnosis

    Time frame: Starting from January1st 2014 until January 30th 2018

    Change of preliminary diagnosis made by ED physician compared to diagnosis after admission to hospital, or after readmission to ED

  4. physician mistakes

    Time frame: Starting from January1st 2014 until January 30th 2018

    Errors made by ED physician in the management of patients in the ED

  5. Admission to hospital

    Time frame: Starting from January1st 2014 until January 30th 2018

    The rate of hospitalization compred to the rate of discharge from ED

  6. return to ED after discharge

    Time frame: Starting from January1st 2014 until January 30th 2018

    patients returning to hospital within 30 days of discharge from ED

  7. Time till being seen by a physician

    Time frame: Starting from January1st 2014 until January 30th 2018

    We measure the time it took for the patient to be seen by an ED physician

Sponsors and collaborators

Lead sponsor

Sheba Medical Center

Other Gov

Collaborators

  • Dr. Avinoah Irony
  • Dr. Gabrieal Breuer
  • Dr. Michael Dreyfuss
  • Dr. Yahel Giat
  • Pr. Merav Lidar

Registry information

Official study title

Characterizing ER Activities for Failure Prevention

Important dates

Study start
2013
Primary completion
2017
Study completion
2017
First posted
May 9, 2019
Registry last updated
May 9, 2019

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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