Article Text
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.
- root cause analysis
- quality improvement
- emergency medicine
- workload
This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
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Footnotes
Contributors All authors contributed to the design and writing, data collection and interpretation of the results of this study.
Competing interests None declared.
Ethics approval The SingHealth Centralised Institutional Review Board exempted the study from ethical approval as the work was deemed a quality improvement study and not a study on human subjects.
Provenance and peer review Not commissioned; externally peer reviewed.