Impact of a Hospitalwide Quality Improvement Initiative on Emergency Department Throughput and Crowding Measures

Melton, James D.; Blind, Fred; Hall, A. Brad; Leckie, Maureen; Novotny, April

doi:10.1016/s1553-7250(16)30104-0

Cited by 8 publications

(4 citation statements)

References 35 publications

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“…9 Decreased length of stay, decreased waiting time to be seen, decreased throughput time, reduced adverse events, and improved patient satisfaction are among the commonly described improved care processes and patient care outcome eforts. 5,9,10,[17][18][19][20][21][22] Reduced throughput from the initial visit to treatment plan was described as a primary objective in our project. Our reduction-35 to eight business days, a 72% reduction-is in line with reports of other Lean interventions.…”

Section: Discussionmentioning

confidence: 99%

Clinical Integration in a Dental School Clinic Through an Enhanced Patient Intake Process

Robinson

Fischbach

Salisbury

et al. 2019

Journal of Dental Education

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Dental care in the U.S. is based on a general practice model of care delivery that can be enhanced by the integration of the dentists and allied dental professionals. There are 25 U.S. dental schools with associated dental hygiene programs, presenting distinctive opportunities for educating the dental health care team. Integrated educational clinical experiences are believed to positively influence teamwork and quality of care that parallels the authentic general practice environment. Lean management, developed by Toyota and used in a variety of types of organizations including health care, provides a distinctive blend of engineering principles and operations management to enhance business and operations processes. A fundamental principle of Lean management is the elimination of waste and preservation of only those value‐added components of a process. The faculty and staff of The Ohio State University College of Dentistry, trained in Lean process improvement, applied techniques to enhance and integrate an inefficient patient intake (admissions) process. The aim of this initiative was to improve patient throughput in the patient intake process and to provide dental and dental hygiene students with enhanced educational experiences from improved clinical integration. These goals were achieved through streamlining patient flow and relocating major phases of the process. Although new patient retention and cancellation/no‐show rates remained mostly unchanged, this enhancement project resulted in improved access to care, improved continuity of care, expanded scope of dental services offered, improved patient satisfaction, and enhanced dental and dental hygiene student collaboration and teamwork. These outcomes suggest that process improvement initiatives can serve as valuable opportunities for integration of the dental health care team.

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Section: Discussionmentioning

confidence: 99%

Clinical Integration in a Dental School Clinic Through an Enhanced Patient Intake Process

Robinson

Fischbach

Salisbury

et al. 2019

Journal of Dental Education

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“…While mitigation is most often used as a term to strengthen the physical infrastructure of a hospital, frontline nurses could be considered as human infrastructure and the actions required of nurses during a disaster response are often the same activities performed every day, but with increased speed, intensity, and volume. Inefficiencies in patient flow are associated with poor patient care outcomes [23,24] and, left unaddressed, chronic inefficiencies (e.g., delays in care, supply chain issues, inadequate or lack of resources, etc.) are likely to worsen under the pressure of a disaster [25].…”

Section: Novel Approaches To Enhance Traditional Disaster Preparednes...mentioning

confidence: 99%

Culture of Safety and Preparedness: Benefits of Applying a Daily Mitigation Mindset in the Hospital Setting

Griffin,

Dobalian,

Langan

et al. 2024

IJERPH

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Aim: Utilizing the subjective experience of nurse executives who have supervised nurses during a major disaster in a hospital setting, this study aims to describe the subjective experience of nurse executives (NE) who have supervised nurses’ responses to major disasters. This paper will focus on strategies to support nursing response to disasters, specifically to strengthen resiliency and the ability to maintain function despite the shock of a disaster, including those caused by climate change. Methods: Semi-structured interviews were conducted with 11 hospital-based nurse executives who supervised nurses during some of the worst natural and human-made disasters in different regions of the United States. A phenomenological approach was used to analyze and describe emerging themes from the qualitative data. Results: Three nurse executives demonstrated theme saturation for mitigation steps to augment traditional disaster readiness activities: (1) Assessment of human infrastructure: daily skills needed during disaster response; (2) Identification and study of failure points and metrics; (3) Strengthening human infrastructure: rectifying deficiencies; and (4) Monitoring metrics and making corrections during conventional periods. Conclusion: Mitigation steps may improve outcomes in hospital function during conventional times; therefore, these steps may improve resiliency and the ability to maintain functions during major disasters, including climate change.

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“…Figure 1 illustrates how it is its configuration. The throughput is a function of patient volume (input) and acuity, length of stay, and time required for patient admission, hospitalization or discharge (output) (MELTON et al, 2016). Comprehending the purpose of these components and their relationship with each other helps to understand the aspects that directly influence overload and overcrowding that affects E.D.…”

Section: Emergency Department (Ed)mentioning

confidence: 99%

“…In the USA, lean concepts have been adapted to improve emergency service care throughput and patient satisfaction (KANE et al, 2015). In Melton et al (2016), the rate of patients leaving ED without care decreased from 4% to 0.49% after efforts directed to aspects related to the throughput. In Australia and Canada, the increase in output resources has had more impacts on reducing patients' length of stay in emergency departments than efforts in input and throughput components (CHENG et al, 2019).…”

Section: Emergency Department (Ed)mentioning

confidence: 99%

Discrete event simulation for problem solving in the context of an emergency department

Ferreira

Santos

et al. 2020

Ind. Jour. Manag. & Prod.

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Emergency departments (ED) are responsible for the immediate care and stabilization of patients in critical health conditions. Several factors have caused overcrowding in the emergency care system, but the variability of patient arrival and the triage process requires special attention. The criticality of these components and their configuration directly impact the waiting times, length of stay and quality of service, being the subject of several studies. So, this paper aims to understand by means of Discrete Event Simulation how ED works with the variation of patient arrival and how this variation highlights the bottlenecks of the triage process. Varying the patient arriving interval between 0.1 and 7.6 in a 4-hour scenario, the system saturation point was established in β = 1.1. Besides, with the variation in the number of triages points, a considerable decrease in the total length of stay spent and the waiting times were noticed, mainly when there was two triage points operating simultaneously.

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Impact of a Hospitalwide Quality Improvement Initiative on Emergency Department Throughput and Crowding Measures

Cited by 8 publications

References 35 publications

Clinical Integration in a Dental School Clinic Through an Enhanced Patient Intake Process

Clinical Integration in a Dental School Clinic Through an Enhanced Patient Intake Process

Culture of Safety and Preparedness: Benefits of Applying a Daily Mitigation Mindset in the Hospital Setting

Discrete event simulation for problem solving in the context of an emergency department

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