PMID- 27748221
OWN - NLM
STAT- MEDLINE
DCOM- 20171207
LR  - 20220409
IS  - 1481-8043 (Electronic)
IS  - 1481-8035 (Linking)
VI  - 19
IP  - 2
DP  - 2017 Mar
TI  - Impact of process improvements on measures of emergency department efficiency.
PG  - 96-105
LID - 10.1017/cem.2016.382 [doi]
AB  - OBJECTIVE: To study the operational impact of process improvements on emergency 
      department (ED) patient flow. The changes did not require any increase in 
      resources or expenditures. METHODS: This was a 36-month pre- and 
      post-intervention study to evaluate the effect of implementing process 
      improvements at a community ED from January 2010 to December 2012. The 
      intervention comprised streamlining triage by having patients accepted into 
      internal waiting areas immediately after triage. Within the ED, parallel 
      processes unfolded, and there was no restriction on when registration occurred or 
      which health care provider a patient saw first. Flexible nursing ratios allowed 
      nursing staff to redeploy and move to areas of highest demand. Last, demand-based 
      physician scheduling was implemented. The main outcome was length of stay (LOS). 
      Secondary outcomes included time to physician initial assessment (PIA), 
      left-without-being-seen (LWBS) rates, and left-against-medical-advice (LAMA) 
      rates. Segmented regression of interrupted time series analysis was performed to 
      quantify the impact of the intervention, and whether it was sustained. RESULTS: 
      Patients totalling 251,899 attended the ED during the study period. Daily patient 
      volumes increased 17.3% during the post-intervention period. Post-intervention, 
      mean LOS decreased by 0.64 hours (p<0.005). LOS for non-admitted Canadian Triage 
      and Acuity Scale 2 (-0.58 hours, p<0.005), 3 (-0.75 hours, p<0.005), and 4 (-0.32 
      hours, p<0.005) patients also decreased. There were reductions in PIA (43.81 
      minutes, p<0.005), LWBS (35.2%, p<0.005), and LAMA (61.9%, p<0.005). CONCLUSION: 
      A combination of process improvements in the ED was associated with clinically 
      significant reductions in LOS, PIA, LWBS, and LAMA for non-resuscitative 
      patients.
FAU - Leung, Alexander K
AU  - Leung AK
AD  - *Department of Family Medicine,Queen's University,Kingston,ON.
FAU - Whatley, Shawn D
AU  - Whatley SD
AD  - daggerSouthlake Regional Health Centre,Emergency Services Program,Newmarket,ON.
FAU - Gao, Dechang
AU  - Gao D
AD  - double daggerDepartment of Statistics,University of Toronto,Toronto,ON.
FAU - Duic, Marko
AU  - Duic M
AD  - daggerSouthlake Regional Health Centre,Emergency Services Program,Newmarket,ON.
LA  - eng
PT  - Journal Article
DEP - 20161017
PL  - England
TA  - CJEM
JT  - CJEM
JID - 100893237
SB  - IM
MH  - Adult
MH  - *Efficiency, Organizational
MH  - Emergency Service, Hospital/*standards
MH  - Female
MH  - Humans
MH  - Male
MH  - Personnel Staffing and Scheduling
MH  - *Process Assessment, Health Care
MH  - *Quality Improvement
MH  - Triage
OTO - NOTNLM
OT  - efficiency
OT  - length of stay
OT  - patient flow
EDAT- 2016/10/18 06:00
MHDA- 2017/12/08 06:00
CRDT- 2016/10/18 06:00
PHST- 2016/10/18 06:00 [pubmed]
PHST- 2017/12/08 06:00 [medline]
PHST- 2016/10/18 06:00 [entrez]
AID - S1481803516003821 [pii]
AID - 10.1017/cem.2016.382 [doi]
PST - ppublish
SO  - CJEM. 2017 Mar;19(2):96-105. doi: 10.1017/cem.2016.382. Epub 2016 Oct 17.