1660 patients presented during the study period with an average ED length of stay,including boarder time, of 8hr 18 minutes, an average door to physician time of 1hr40 minutes and door to room time of 56minutes. 53 patients LWOT (3.2%), withan average 6pm waiting room census of 6 patients. 131 patients were enrolled underthe PDQ methodology. Of these patients the PDQ took primary responsibility for 39(29.3%), with 92 (71.3%) required complex diagnostic/therapeutic interventions anda room. 36 of 39 primary PDQ patients were discharged, and 3 were observed. Theaverage length of stay for the 39 was 2hrs. Of the 92, 68 (74%) were discharged while24 (26%)were admitted. For all 131 patients, average door to doctor time was 2 minwith an average door to room time of 14 minutes. 0 patients LWOT and the was a 0patients waiting room census at 6pm

Conclusions: Preliminary data suggests that by applying queueing theory to thearrival of patients utilizing PDQ, significant improvements can be made in efficiency,LWOT and door to doctor and room time without physical plant expansion.Additional investigation into application in other ED phases of care or health caredelivery outside the ED is warrented.

401 Clinical Course and Associated Factor ofReexpansion Pulmonary Edema in Non-traumaticSpontaneous Pneumothorax

Kim H, Lee IK/Wonju College of Medicine, Wonju, Republic of Korea

Study objective: Reexpansion pulmonary edema (REPE) is a rare, sometimes fatalcomplication that occurs after the rapid reexpansion of a collapsed lung followingdrainage and evacuation of pleural disease, such as pneumothoax, hydrothorax, orhemothorax. We performed this study to evaluate clinical course and associated factorof REPE developing in non-traumatic spontaneous pneumothorax.

Methods: We conducted a prospective study of 87 patients (male 77, mean age37 years) who were presented with non-traumatic spontaneous pneumothorax fromJanuary 2003 to February 2006. We performed chest CT scan after closedthoracostomy. We divided REPE and non-REPE group and compare with clinicalcharacteristics and associated factor.

Results: REPE develops in 25 patients (28.7%) after closed thoracostomy. Thepneumothorax size was significantly different between REPE and non-REPE group(85.4�42.2% vs 51.9�28.9%, p�0.001). The incidence rate of REPE is 88% inabove 40% of pneumothorax size and 12% in below 40% of it (p�0.003). Age, sex,symptom duration, serum BNP level, PaO2, PaCO2, SaO2, and lactate level werenot different between REPE and non-REPE group. There was no mortality case andrecover in 7 days for all patients.

Conclusion: REPE is develops in high proportion (28.7%) after closedthoracostomy (common complication) and has reversible course in 7 days in non-traumatic spontaneous pneumothorax. REPE increases incidence rate whenpneumothorax size is more than 40%.

402 BEST “Better Early Stroke Treatment”:Implementation of an Acute Stroke PathwayImproves Emergency Department Throughput

Hoff AM, Yassa AS, Bellolio MF, Gilmore RM, Boie ET, Kashyap R, Enduri S,Vaidyanathan L, Wood HM, Decker WW, Stead LG/Mayo Clinic College ofMedicine. Division of Emergency Medicine Research, Rochester, MN

Study Objective: To study whether implementation of an acute stroke carepathway led to faster throughput of patients, given the emphasis of “time is brain”and current overcapacity trends.

Methods: A random cohort of 140 and 116 patients respectively were collectedbefore and after implementation of the “Better Early Stroke Treatment” (BEST)pathway in our tertiary care emergency department with over 77,000 visits a year.Sampling was performed using the methodology prescribed by JCAHO. Onlypatients who were admitted via the ED with an acute ischemic stroke (AIS) wereincluded.

The elements of BEST include:- triage to a specialized (critical) area- standardized battery of tests- real time (ED) patient education of warning signs and risk factors- CT PriorityData collected included:1) Symptom onset to ED presentation2) Door to CT time3) ED length of stay (ED LOS) and4) Area patient triaged

Statistical analyses were performed in JMP software, SAS institute, Version 6.0, withanalysis of variance, t-test and Pearson Chi-Square test for normally distributedvariables and Wilcoxon/Kruskal-Wallis test for non-normally distributed variables.

Results: Implementation of a dedicated acute stroke pathway resulted in moreefficient ED care, with statistically significant shorter door to CT time. In the overallcohort, patients roomed in the critical area were significantly more likely to haveshorter ED LOS times compared to those who went to regular acute care areas(Mean�SD, 3:34�1:16 vs. 4:26�1:37; p�0.001).

Conclusion: Implementation of an acute stroke pathway can enhance EDthroughput, which in disease states such as acute stroke can be of paramountimportance. Triage of stroke to the higher acuity areas also helps to shorten door toCT time.

Research Forum Abstracts

S126 Annals of Emergency Medicine Volume , . : September