Advancing the Science

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February 28, 2019

Feeling lonely in the emergency department? It may matter more than you think.

By Elizabeth Zimmermann

Waiting in the emergency room is not only frustrating for patients, but could contribute to future hospitalizations, shows new research.

A collaborative team within the Mayo Clinic Emergency Department Clinical Engineering Learning Laboratory is working to improve the quality of care in emergency medicine. Researchers and health care providers work hand-in-hand in this embedded research lab to enhance patient and provider experiences, increase efficiency and improve outcomes for patients everywhere.

In their current study, led by Mustafa Sir, Ph.D., the team observed 13,714 adult and 2,854 pediatric patients placed in an acute care room for treatment in the Emergency Department at Mayo Clinic in Rochester, Minn., between May 1 and July 31, 2016.

“It appears that the length of time patients spend in a treatment room without hospital staff present is related to hospitalization within 30 days following their ED visit,” says Dr. Sir. “Our data shows that every hour a patient spends alone increases the likelihood of hospitalization within 30 days by approximately 6 percent.”

Of all the patients, 22.8 percent were admitted to the hospital during the initial emergency visit, with 13.8 percent (523) of those patients then re-admitted within 30 days.

Of the 12,786 patients discharged from the emergency department, 6.2 percent were subsequently admitted during the following 30 days. Patients that were not hospitalized in 30 days had on average about 25 minutes less alone time compared to those who were hospitalized.

Making connections

The team measured this “patient alone time” three different ways:

  • Total: cumulative time spent alone throughout visit, excluding any portions during which the patient was under observation or in isolation
  • Maximum: longest individual length of time spent alone
  • Percentage: total alone time divided by total treatment room time

They found that pediatric (ages 0-17) patients have the lowest total and maximum alone times, but the highest percentage patient alone time of all patients.

Among adult patients only, seniors (age > 65) stood out, with higher total and maximum alone times. There were no significant differences in percentage alone.

The study results also include information on potential correlations among factors including marital status; patient geographic home – local, regional, national, international; and sex.

What does it mean?

Adjusting for a number of different factors that could potentially influence 30-day hospital admission; the team found that total patient alone time was the only one of the three measurements that was statistically significant.

“Our findings indicate that for every hour a patient spends alone in the ED treatment room, they are 5.6 percent more likely to be admitted, or readmitted, to the hospital within 30 days,” says Heather Heaton, M.D., an emergency medicine physician at Mayo Clinic and study co-author.

“How long patients spend alone, in general, is influenced by how full our ED is,” she says. “Effective triaging and initial physician evaluations seem to reduce alone time for patients with more complex medical situations.”

While the team still has more research they need to do, Dr. Heaton says that she believes even brief check-ins by the physician or other member of the care team could make a difference.

“Although we don’t understand the causal pathway yet, it’s sometimes the simplest things that make a difference,” she says.

“We don’t have the evidence yet to develop evidence-based interventions,” says Dr. Sir, “but we are working on it. This is one of the first studies to examine patient alone time in the ED, and provides critical information for our understanding of ways to improve patient outcomes.”

Future work planned by the Mayo Clinic Emergency Department Clinical Engineering Learning Laboratory team includes analyzing a broader set of characteristic and clinical outcome variables, Dr. Sir says.

Also involved in this study was Adam VanDeusen (@adam_vandeusen), University of Michigan; and from Mayo Clinic: Kalyan Pasupathy, Ph.D.; Todd Huschka; and Thomas Hellmich, M.D. (@Thellmich)

The embedded research model used in the lab was developed within the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery. Center researchers collaborate with clinical care and administrative colleagues from across Mayo Clinic and beyond, to discover new ways to improve health; translate those discoveries into evidence-based, actionable treatments, processes and procedures; and apply this new knowledge to improve care for patients everywhere.

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Tags: Center for the Science of Health Care Delivery, emergency department, Findings, health care systems engineering, Heather Heaton, Mustafa Sir, News, patient safety

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