Affiliation: Gillings School of Global Public Health, Department of Health Policy and Management
The objectives of this research were to: (1) estimate the association between adopting emergency department (ED) crowding interventions and EDs’ core performance measures; (2) explore the key barriers and enablers associated with Full Capacity Protocol (FCP) adoption; and (3) identify the core components of FCP and the key determinants of successful FCP implementation.
In the first study I analyzed the National Hospital Ambulatory Medical Care Survey (NHAMCS) data from 2007– 2015. Controlling for patient-level, hospital level and temporal confounders I analyzed and report results using multivariable logit model. Key findings include:
• There has been an increase in the adoption rate of ED crowding interventions especially technology-based interventions.
• Waiting time and the percentage of patients who left the ED without being seen (LWBS) has significantly decreased.
• Adopting kiosk check-in technology is associated with a decrease in the odds of prolonged waiting time.
• Having a fast track and an ED observation unit is associated with an increase in the odds of prolonged ED LOS for discharged and admitted patients, and prolonged waiting time.
Second study was a mixed-methods study. For the quantitative component, I analyzed the NHAMCS data from 2007– 2015. For the qualitative component, I interviewed 32 key representatives of hospital and ED operations across the US. I used the Consolidated Framework for Implementation Research (CFIR) to develop an interview guide, to create a template to code the interview transcripts, and to analyze the data. I found that determinants such as tension for change, history of adopting other ED crowding interventions, leadership support, fear of exacerbating ED crowding because of other nearby crowded EDs (i.e., domino effect), resistance from nurse managers, external regulations and policies, and hospital culture had a great impact on FCP adoption.
In the third study, using CFIR, I interviewed 24 key representatives of hospital and ED operations across the US. Among the most dominant barriers to FCP implementation are reaching consensus about the criteria for activation of each level of FCP and actions within each level of FCP, lack of leadership support and commitment, difficulty changing the hospital’s culture, and resistanc