Improving the wait time to consultation at the emergency department

Abstract

Prolonged wait times at the emergency department (ED) are associated with increased morbidity and mortality, and decreased patient satisfaction. Reducing wait times at the ED is challenging. The objective of this study is to determine if the implementation of a series of interventions would help decrease the wait time to consultation (WTC) for patients at the ED within 6 months. Interventions include creation of a common board detailing work output, matching manpower to patient arrivals and adopting a team-based model of care. A retrospective analysis of the period from January 2015 to May 2016 was undertaken to define baseline duration for WTC. Rapid PDSA (Plan, Do, Study, Act) cycles were used to implement a series of interventions, and changes in wait time were tracked, with concurrent patient load, rostered manpower and number of admissions from ED. Results of the interventions were tracked from 1 October 2016 to 30 April 2017. There was improvement in WTC within 6 months of initiation of interventions. The improvements demonstrated appeared consistent and sustained. The average 95th centile WTC decreased by 38 min to 124 min, from the baseline duration of 162 min. The median WTC improved to 21 min, compared with a baseline timing of 24 min. The improvements occurred despite greater patient load of 4317 patients per month, compared with baseline monthly average of 4053 patients. There was no increase in admissions from ED and no change in the amount of ED manpower over the same period. We demonstrate how implementation of low-cost interventions, enabling transparency, equitable workload and use of a team-based care model can help to bring down wait times for patients. Quality improvement efforts were sustained by employing a data-driven approach, support from senior clinicians and providing constant feedback on outcomes.

Tiempo de espera para atención médica urgente en un hospital terciario después de implementar un programa de mejora de procesos

“…No se encontraron estudios locales respecto a implementación de medidas de mejora en servicios de emergencia con pacientes de prioridad III; sin embargo, los tiempos de espera del estudio se acercan a lo recomendado y son mucho menores que lo reportado previamente (18) , incluso mejorando con el transcurrir de los meses de funcionamiento del programa de facilitadores de procesos. Un estudio realizado en Singapur muestra disminución de tiempos de espera después de implementar medidas de gestión, pero en pacientes de prioridad II (19) .…”

Provider interruptions and patient perceptions of care: an observational study in the emergency department

“…Although we do not advocate for increasing coordination-related interruptions, our finding points to the necessity of allowing these interactions in ED work since the resulting activities and mutual information exchange between providers might foster ED patient flow. Interventions addressing proactive forms of coordination activities within provider teams, for example, unit huddles39 or white boards with patient status information,40 should further examine whether these innovations lead to fewer coordination-related interruptions and if these approaches fit with ED unit culture, that is, if they are accepted and employed by ED providers.…”

A Decision Support Platform based on Cross-Sorting Methods for the Selection of Modeling Methods

“… Improvement of the decision-making organization and reduction of the hospitalization duration [20]  Reduction of the waiting time in emergency unit [21]  Reduction of the time spent by the patient in the emergency units and improvement of its performances [22]  Restructuration of medical personnel assignment problem [23]  Minimization of the pharmaceutical supply chain expenditures.…”