• Arjun Chanmugam and Jessica L Bienstock.
• Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, Maryland 21287, USA.
• J Emerg Med. 2013 Jan 1;44(1):217-24.

BackgroundThe use of multidisciplinary algorithmic pathways is one strategy to improve efficiency and quality of care in Emergency Departments (EDs). To this end, in the fall of 2005, we implemented algorithmic pathways for evaluation of ED patients with common gynecologic complaints.ObjectivesThe goals of this initiative were to improve length of stay as a marker for operational efficiency and to reduce health care disparities by ensuring consistent management regimens for all patients.MethodsA retrospective observational comparison study was performed through a review of consults in the year preceding and the year after implementation of the pathways. The length of stay was calculated based on time of initial triage until discharge. The length of stay from both groups was compared using an unpaired Student's t-test analysis.ResultsThere was an 85-min decrease in the mean visit time between the pre-intervention group (108 patients, 610 min, SD 345.4) and the post-intervention group (105 patients, 525 min, SD 251.5), p=0.04.ConclusionsAlgorithmic pathways had a positive impact on patient care as measured by the average amount of time our patients spent in the ED. Gynecologic care in the ED was standardized, and length of stay for patients with gynecologic complaints decreased. The implementation of algorithms resulted in more consistent care with earlier initiation of pertinent studies, while facilitating more rapid critical decision-making by providers from both departments. Further analysis is required to examine cost-effectiveness as well as patient safety and provider satisfaction issues.Copyright © 2013 Elsevier Inc. All rights reserved.

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