LWW/JNCQ LWWJ288-16 November 20, 2006 17:44 Char Count= 0 J Nurs Care Qual Vol. 22, No. 1, pp. 85–91 c  2007 Lippincott Williams & Wilkins, Inc. Patient Flow in the Emergency Department Is Timeliness to Events Related to Length of Hospital Stay? Karen Clark, PhD, RN, CCRN; Loretta Brush Normile, PhD, RN Management of critically ill patients occurs frequently in emergency departments (ED) while wait- ing for intensive care beds to become available. The purpose of this study was to investigate effects of timeliness of interventions in the ED on ED outcomes and hospital length of stay. Sample size was 1536 intensive care unit admissions. Timeliness to first medication and order for intensive care unit bed to leaving the ED influenced both ED and hospital length of stay. Timely interventions affect outcomes, access, and quality of care. Key words: critical care admissions, emergency department, hospital outcomes, interventions, length of stay W HEN patients arrive in the emer- gency department (ED) with a life- threatening condition, the expectation is that they will receive a speedy assessment and rapid initial management of their condi- tion, and efficient transfer to an appropriate specialty unit such as critical care. Health- care professionals and consumers across the United States recognize that care in EDs is be- coming increasingly complicated. Profession- als involved in delivering care find themselves implementing more and more interventions over longer ED patient stays. Consider this re- cent experience of an ED nurse in a large med- ical center in the mid-Atlantic area: From the Department of Organizational Systems and Adult Health, University of Maryland Baltimore School of Nursing (Dr Clark); and College of Health and Human Health Sciences, George Mason University, Fairfax, Va (Dr Normile). The authors thank Sigma Theta Tau, Epsilon Zeta Chap- ter, for providing partial funding for this research. Corresponding author: Karen Clark, PhD, RN, CCRN, Shady Grove Center, University of Maryland, 9640 Gudelsky Dr, 313, Rockville, MD 20850 (e-mail: kclar006@son.umaryland.edu). Accepted for publication: July 24, 2006 The shift in the ED started out busy with 3 critical care patients boarded in the ED, including a patient who had a malfunctioning pacemaker. This patient had an immediate need for an ICU bed. Unfortu- nately the ICU was full, and the nursing supervi- sor tried to work miracles to get an ICU bed. After nearly 4 hours the doctor decided telemetry would be sufficient in the absence of an ICU bed, but the patient would need one-to-one attention from a nurse. Even with the change, it was not until 6 hours later before a bed was available. Interventions or events provided in the ED for admissions originating in the ED can af- fect patient outcomes. Derlet and Richards 1 and Derlet et al 2 addressed prolonged waits in EDs as safety risks potentially leading to poor outcomes. The National Hospital Ambu- latory Medical Care surveys of EDs have been done over a period of years. The more recent surveys have included frequencies of inter- ventions for medications, radiological studies, blood work, and waiting time to being seen by ED physicians. 3–6 Specific times to interven- tions such as medications, radiological exami- nations, and blood work were not included in the data. With each subsequent year, though, the percentage of interventions provided to patients has increased. 85