Background. Emergency department (ED) overcrowding is a worldwide problem that poses a threat to patient safety by causing\ntreatment delays and increasing mortality. Consultations are common and important in the emergency medicine profession and\nare associated with longer ED length of stay (LOS). The purpose of this study was to evaluate the impact of admission decisions by\nemergency physicians without consultations on the ED LOS and other quality indicators. Methods. The study was a retrospective\nobservational study comparing the ED LOS of patients admitted to the internal medicine (IM) department before and after the\npolicy change regarding admission decisions that was implemented in October 2016. During and after the policy change,\nemergency physicians decided how to arrange for and treat medical patients by processing their admission and providing followup\ncare without consultations. The ED LOS and other indicators of patients admitted to the IM department were compared\nbetween the study period (January to June 2017) and the control period (January to June 2016). Results. The median ED LOS of\npatients admitted to the IM department decreased from 673 (IQR: 347â??1,369) minutes in the control period to 237 (IQR: 166â??364)\nminutes in the study period. There were no significant differences in the interdepartmental transfer rate or in-hospital mortality\nbetween the two periods. Conclusions. Theadmission decisions regarding medical patients made by emergency physicians without\nspecialty consultations reduced the ED LOS without a significant negative effect on mortality or hospital LOS.
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