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Emergency Department Crowding and Time at the Bedside: A Wearable Technology Feasibility Study

Published:April 25, 2018DOI:https://doi.org/10.1016/j.jen.2018.03.005

      Abstract

      Introduction

      ED crowding is a public health crisis, limiting quality and access to lifesaving care. The purpose of this study was to (1) evaluate the feasibility of radio-frequency identification tags to measure clinician-patient contact and (2) to test the relationship between ED occupancy and clinician-patient contact time.

      Methods

      In this 4-week observational study, radio-frequency identification tags were worn by emergency clinicians in a 21-bay urban teaching hospital emergency department. The time-motion data were merged with electronic medical repository patient information (N = 3,237) to adjust for occupancy, age, gender, and acuity. Qualitative themes were generated from focus group (N = 39) debriefings of the quantitative results.

      Results

      Data were collected on 56,342 total clinician events. Adjusting for patient age, increasing ED occupancy increased the number of times the attending physician entered and left the patient room (b = 0 .008, 95% confidence interval [CI] = [0.001-0.016], P = 0.03). There was no relationship for patient gender, triage acuity, shift at arrival, disposition to home, or discharge diagnosis category with either total minutes or number of encounters per patient visit. No time-motion and occupancy associations were observed for nurses, residents, or nurse practitioners/physician assistants. Debriefings indicated occupancy influenced the quality of care, despite maintaining the same quantity of contact time.

      Discussion

      The physical environment and clinician privacy concerns limit the feasibility of wearable tracking technology in the emergency setting. Attending physician care becomes more fragmented with increasing ED occupancy. Other clinicians report changes in the quality of care, whereas the quantity of time and encounters were unchanged with occupancy rates.
      Contribution to Emergency Nursing Practice
      • The current state of scientific knowledge on clinical-patient contact time indicates ED crowding may be detrimental to the quality, quantity, and consistency of care.
      • The main findings of this research include the following: As occupancy increases, we did not observe differences in time and motion for nurses and nurse practitioners/physician assistants, and we found that attending-physician care becomes more fragmented. There are several physical, architectural barriers to deploying radio-frequency identification tags in the emergency setting. Participating clinicians relayed several qualitative benefits and drawbacks to wearable tracking technology.
      • Key implications for emergency nursing practice indicate that additional revisions and considerations are needed to enhance wearable tracker feasibility for emergency clinicians.

      Keywords

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      Biography

      Jessica Castner, Member, Western New York ENA Chapter, is President, Castner Incorporated; President Healthcare Research Consulting, Inc.; Faculty, D'Youville College School of Nursing; University at Buffalo School of Nursing; School of Public Health and Health Professions, Epidemiology and Environmental Health; Jacobs School of Medicine and Biomedical Sciences, Biomedical Informatics; and School of Engineering and Applied Sciences, Biomedical Engineering, Buffalo, NY.

      Biography

      Heidi Suffoletto is Clinical Assistant Professor at University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Department of Emergency Medicine, Buffalo, NY.