Emergency department census of patients awaiting admission following reorganisation of an admissions process

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Abstract
Objectives: To determine the impact of reorganisation of an acute admissions process on numbers of people in the emergency department (ED) awaiting admission to a hospital bed in a major teaching hospital. Methods: We studied all emergency medical patients admitted to St James’ Hospital, Dublin, between 1 January 2002 and 31 December 2004. In 2002, patients were admitted to a variety of wards from the ED when a hospital bed became available. In 2003, two centrally located wards were reconfigured to function as an acute medical admissions unit (AMAU) (bed capacity 59), and all emergency patients were admitted directly to this unit from the ED (average 15 admissions per day). The maximum permitted length of stay on the AMAU was 5 days. We recorded the number of patients in the ED, who were awaiting the availability of a hospital bed, at 0700 and 1700 on the days of recording during the 36 month study period. Results: The impact of the AMAU reduced overall hospital length of stay from 7 days in 2002 to 5 days in 2003 and 2004 (pConclusions: This study found that reorganisation of a system for acute medical admissions can significantly impact on the number of patients awaiting admission to a hospital bed, and allow an ED to operate efficiently and at a level of risk acceptable to patients.