Effectiveness of digital consultation in reducing emergency department length of stay

Natan Mulubrhan Alemseged; Melaku  Getachew; Derejie  Woldasilase; Fenta  Wondimneh; Ellen J  Weber

doi:10.18502/fem.v9i3.20019

Natan Mulubrhan Alemseged Department of Emergency and Critical Care Medicine, School of Medicine, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
Melaku Getachew Department of Emergency and Critical Care Medicine, School of Medicine, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
Derejie Woldasilase Department of Radiology, School of Medicine, Haramaya University, Harar, Ethiopia.3. School of Nursing, Haramaya University, Harar, Ethiopia.
Fenta Wondimneh School of Nursing, Haramaya University, Harar, Ethiopia.
Ellen J Weber Department of Emergency Medicine, University of California San Francisco, San Francisco, California, USA.

DOI: https://doi.org/10.18502/fem.v9i3.20019

Keywords: Crowding; Digital Consultation; Emergency Department; Information Technology; Length of Stay; Patient Outcomes

Abstract

Abstract:

Objective: Emergency department length of stay (EDLOS) is a critical measure of healthcare efficiency and quality, and prolonged stays are associated with worse outcomes, particularly for patients requiring intensive care unit (ICU) admission. This study evaluates the impact of a digital consultation management system implemented at Hiwot Fana Comprehensive University Hospital in Ethiopia between May 2020 and May 2024.

Methods: A pre–post quasi-experimental design was utilized to compare EDLOS for ICU patients before and after the implementation of the new consultation system. The traditional consultation process was characterized by multi-step verbal communication among healthcare providers. The new system employed a secure Telegram channel to facilitate real-time communication, whereby all physicians in the consulting service were simultaneously notified of the patient requiring ICU care. We determined the proportion of patients admitted to the ICU staying more than 24 hours in the emergency department (ED) between pre- and post-implementation of the Telegram system using chi-squared tests and mean difference in LOS using Mann Whitney U.

Results: This study included 415 patients with 202 patients in the pre-implementation period (May 01, 2020, to May 31, 2022) and 213 in the post-implementation period (June 01, 2022, to May 31, 2024). The mean age was 43.3 years (SD: 18.75 years), and no significant demographic or clinical differences were observed between the pre- and post-intervention groups, except for payment method. Before implementation, 32.6% of patients stayed in the ED> 24 hours while after the implementation 28.8% stayed > 24 hours (P=0.03) The mean EDLOS decreased from 2.83 (SD: 2.5) days to 2.27(SD: 1.64) days following implementation (P=0.04), with a reduction of approximately 13.2 hours in EDLOS. Overall ICU mortality decreased from 31.4% to 25.8%, though this was not statistically significant.

Conclusion: A digital consultation system can reduce EDLOS in a limited-income country, consistent with findings from similar studies. Further research is needed to explore long-term impacts and scalability, especially in low-resource settings.