The impact of process re-engineering on patient throughput in emergency departments in the UK

Abstract

BackgroundThe re-engineering of emergency department (ED) processes in the UK since 2002 has produced significant reductions in waiting times.AimsWe aim to describe the generic themes contributory to this improvement in performance, which has led to progress not yet replicated elsewhere in the English-speaking world.MethodsWe reviewed the Emergency Services Collaborative (ESC) set up by the National Health Service (NHS) Modernisation Agency as well as our own departmental performance in order to identify key themes for discussion. In addition, we reviewed relevant information from the UK Department of Health website. We used the 4-h target of patient passage through the ED as our primary outcome measure.ResultsEarly results from the ESC showed improvements, which have been sustained and enhanced since inception. We use our hospital performance figures to demonstrate a pattern of progressive improvement in performance, with 99.1% of all new attenders in 2007–2008 being seen, treated and discharged or admitted within 4 h of presentation to the ED.ConclusionsThe whole systems approach to re-engineering emergency care has led to universal improvements in patient throughput in EDs in the UK. Several of the concepts found to be useful in the NHS are worthy of consideration and adoption by other health care systems. Long waits in the ED are a thing of the past in the UK.

Emergency department crowding: towards an agenda for evidence-based intervention: Figure 1

“…For example, some make unsubstantiated references to interventions having ‘led to universal improvements in patient throughput in EDs in the UK’ without presenting any actual evidence of change 74. Even the term ‘systematic review’ appears to have been employed loosely in most instances, and many ‘systematic reviews’ do not conform with strict definitions of systematic review common in healthcare 5 12 75 76.…”

Overcrowding in emergency departments: A review of strategies to decrease future challenges

“…[18] Four-hour target has been introduced by health authorities to decrease the LOS in ED. [1920] Despite previous efforts, limited scientific knowledge on how to improve patient flow in ED has achieved. [1]…”

A Relative Safeguard? The Informal Roles that Families and Carers Play when Patients with Dementia are Discharged from Hospital into Care in England and Wales

“…Typically, older people with dementia fade into the background during this decision-making process, while others decide on their relocation into permanent care (Dwyer, 2005). Moreover, decisions about hospital discharge and living arrangements are inextricably linked with diminishing community services and finite hospital resources, where 'effective bed management' and 'improving patient throughput' have become common bywords in hospital discharge planning (Banerjee, Mbamalu and Hinchley, 2008). This can lead to ill-conceived capacity assessments being carried out by professionals on busy hospital wards and best-interests decisions that fail to comply with the legal standards of the MCA (Emmett, Poole, Bond and Hughes, 2013).…”