자료유형  

 학위논문

Control Number  

0017160749

International Standard Book Number  

9798382321301

Dewey Decimal Classification Number  

610

Main Entry-Personal Name  

Vaidya, Ragini Luthra.

Publication, Distribution, etc. (Imprint  

[S.l.] : Yale University., 2024

Publication, Distribution, etc. (Imprint  

Ann Arbor : ProQuest Dissertations & Theses, 2024

Physical Description  

55 p.

General Note  

Source: Dissertations Abstracts International, Volume: 85-11, Section: B.

General Note  

Advisor: Dilip, Monisha.

Dissertation Note  

Thesis (M.D.)--Yale University, 2024.

Summary, Etc.  

요약AimsPooling inpatient bed resources for more efficient bed management is a promising solution to the pervasive problem of Emergency Department crowding. This study aims to characterize a regionalization protocol in place for ED-to-inpatient disposition between a tertiary academic medical center (AMC) and an urban community teaching hospital in an integrated health system, overseen by a single Bed Management Department. An additional purpose of this study is to investigate transfer decisions from a health equity perspective.MethodsThis is a retrospective observational study utilizing electronic admissions records from the two hospitals' Emergency Departments to general medicine floors between January 1, 2020 and December 31, 2020. ED length of stay (LOS), hospital length of stay, acuity level, and demographic characteristics of patients admitted to the academic medical center and those admitted to the neighboring community hospital were assessed by linear regression.ResultsIn the study period, 11,847 patients were admitted from the AMC ED to general medicine services. No differences were found between transferred vs. not transferred patients in terms of acuity, race/ethnicity, or primary language. Patients age 80, female, insured by Medicare or Medicaid, and uninsured were transferred at higher rates. Both mean ED LOS and hospital LOS were statistically significantly shorter for patients transferred to the community hospital compared to those admitted to the AMC. Among patients transferred, the most common chief complaint categories were respiratory symptoms, abdominal symptoms, and focal neurologic symptoms. Patients admitted to the community hospital directly from its own ED experienced shorter ED LOS but longer overall hospital LOS than those transferred from the AMC.ConclusionsTransfers upon admission from an academic medical center ED to a community teaching hospital are feasible in a large proportion of presenting patients. Transferred patients experience lower levels of ED crowding, as measured by ED LOS, and shorter hospital LOS compared to their AMC-admitted counterparts. In implementing a regionalization strategy, financial incentive alignment, risks and benefits of hospital consolidation, and compliance with EMTALA are important considerations.

Subject Added Entry-Topical Term  

Medicine.

Index Term-Uncontrolled  

Admissions

Index Term-Uncontrolled  

Boarding

Index Term-Uncontrolled  

Crowding

Index Term-Uncontrolled  

Regionalization

Index Term-Uncontrolled  

Transfers

Index Term-Uncontrolled  

Utilization

Added Entry-Corporate Name  

Yale University Yale School of Medicine

Host Item Entry  

Dissertations Abstracts International. 85-11B.

Electronic Location and Access  

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Control Number  

joongbu:657935