Beat the clock! Wait times and the production of ‘quality’ in emergency departments

Abstract

Emergency care in large urban hospitals across the country is in the midst of major redesign intended to deliver quality care through improved access, decreased wait times, and maximum efficiency. The central argument in this paper is that the conceptualization of quality including the documentary facts and figures produced to substantiate quality emergency care is socially organized within a powerful ruling discourse that inserts the interests of politics and economics into nurses' work. The Canadian Triage and Acuity Scale figures prominently in the analysis as a high-level organizer of triage work and knowledge production that underpins the way those who administer the system define, measure and evaluate emergency care processes, and then use this information for restructuring. Managerial targets and thinking not only dominate the way emergency work is understood, determined, and controlled but also subsume the actual work of health-care providers in spaces called 'wait times', where it is systematically rendered 'unknowable'. The analysis is supported with evidence from an extensive institutional ethnography that shows what nurses actually do to manage the safe passage of patients through their emergency care process starting with the work of triage nurses.

Performance Improvement Priorities From the Perspective of Emergency Department Staff in Iran’s Hospitals

“…Reducing waiting time and its impact on the treatment cost is another priority at the emergency department. Melon et al (2013) (26) found that increased patient waiting time at this department has affected treatment costs, and by designing appropriate strategies, patients' waiting time at the emergency department can be reduced.…”

Improved outpatient haemodialysis adequacy using queued schedules

“…Whereas queuing approaches aim to improve patient satisfaction, it also important to not sacrifice the quality of service, as highlighted by Melon et al . () and measured as the URR in our study. URR was adopted as the adequacy measure because it had uniform use after becoming the target goal for the US governmental Centers for Medicare and Medicaid Services pay‐for‐performance policy in 2011 (Tangri et al .…”

“…; Melon et al . ) with a focus on emergency departments, primary care clinics, cardiac care, and the adoption of lessons learned from hospitality management. Shan et al .…”

“…This patient response may be related to their feeling a loss of control over their lives, illness and treatment. More recently, there has been increased attention on the efficient delivery of health care (Baarah et al 2012;Soremekun et al 2012;Melon et al 2013) with a focus on emergency departments, primary care clinics, cardiac care, and the adoption of lessons learned from hospitality management. Shan et al (2013) described a robust approach and algorithm to queuing in the outpatient setting using a systems engineering approach to wait time, facility resource utilisation, workflow and spatial constraints.…”

An inquiry into what organised difficult advance care planning conversations in a Scottish residential care home using institutional ethnography

“…Although IE has been taken up in studies of nursing and healthcare internationally (Melon et al 2013, Rankin 2003, 2009, Rankin and Campbell 2009 it is a relatively new method of inquiry for nurse researchers in the UK. Therefore it is also hoped that this paper will introduce IE as a useful method of inquiry to a new audience of nurse researchers interested in understanding how difficulties are produced in real life situations.…”