Patients' satisfaction and wait times at Guelph General Hospital Emergency Department before and after implementation of a process improvement project

Abstract

Objective:A process improvement program (PIP) was implemented in the emergency department (ED) at Guelph General Hospital in July 2009. The purpose of this study was to examine patients' satisfaction and wait times by level of Canadian Triage and Acuity Scale (CTAS) score before and 6 months after implementation of this program.Methods:Two samples were recruited: one was recruited before implementation of the PIP, January to June 2009 (T1), and one was recruited 6 months after implementation, January to June 2010 (T2). Patients were contacted by telephone to administer a survey including patient satisfaction with quality of care. Time to physician initial assessment, numbers left without being seen, and length of stay (LOS) were obtained from hospital records to compare wait times before and 6 months after implementation of the PIP.Results:Patients (n = 301) reported shorter wait times after implementation (e.g., 12% reported seeing a physician right away at T1 compared to 29% at T2). Time to physician initial assessment improved for patients with CTAS scores of III, IV, and V (average decrease from 2.1 to 1.7 hours), fewer patients (n = 425) left without being seen after implementation, and the mean and 90th percentile of LOS decreased for all patients except the mean LOS for discharged patients with a CTAS score of I. Total time spent in the ED for admitted patients decreased from 11.11 hours in the 2009 period to 9.95 in the 2010 period, and for nonadmitted patients, the total time decreased from 3.94 to 3.29 hours. The overall satisfaction score improved from a mean of 3.17 to 3.4 (of 4; p < 0.001).Conclusion:Implementation of the ED PIP corresponded with decreased wait times, increased patient satisfaction, and improved patient flow for patients with CTAS scores of III, IV, and V.

Effect of Triage Nurse Initiated Radiography Using the Ottawa Ankle Rules on Emergency Department Length of Stay at a Tertiary Centre

“…This is in keeping with the literature, which suggests that shorter patient LOS in the ED correlates with improved patient satisfaction. 17,18 Interestingly, we found quality of care ratings were similar in both groups, as was comfort level with triage nurse initiating x-rays.…”

“…11,13,16 What remains unclear, however, is whether or not triage nurse initiated ankle radiography shortens ED patients' length of stay (LOS), a factor known to be correlated with patient satisfaction. 17,18 To date, two studies have examined use of the OAR by triage nurses with ED LOS as the primary outcome. 19,20 One was a retrospective case-control study conducted at an Accident & Emergency Department in a small city.…”

Slow or swift, your patients’ experience won’t drift: absence of correlation between physician productivity and the patient experience

“…For many years, EDs have been struggling with crowding and access block; recently this problem has become particularly dire. [1][2][3][4][5][6] Increased physician productivity (patients seen per hour), may enhance ED operational efficiency if associated with reduced patient wait times, and is financially rewarding to physicians working within volume-incentivised compensation models such as fee-for-service. 7 However, rapid care may limit the duration and quality of physician-patient interactions, which are primary determinants of the patient experience.…”

Patient Flow Analysis in Resource-Limited Settings: A Practical Tutorial and Case Study

“…Overcrowding of health care facilities and inefficient patient flow affect quality and timeliness of care, 1 as well as patient satisfaction 2 , 3 . The mismatch of supply and demand, often experienced in high-volume care settings, such as emergency departments (EDs) in developed countries, is amplified in medical facilities of low- and middle-income countries (LMICs), where they are burdened by a high volume of patients while coping with limited resources and staffing.…”