A qualitative exploration of patient flow in a developing Caribbean emergency department
AbstractObjectivesEmergency departments (EDs) are complex adaptive systems and improving patient flow requires understanding how ED processes work. This is important for developing countries where flow concerns are compounded by resource constraints. The Caribbean is one region with developing emergency care systems and limited research in the area. This study aimed to explore the patient flow process in an emergency department in Trinidad and Tobago, identifying organizational factors influencing patient flow.MethodsMultiple qualitative methods, including non-participant observations, observational process mapping and informal conversational interviews were used to explore patient flow. The process maps were generated from the observational process mapping. Thematic analysis was used to analyze the data.SettingThe study was conducted at a major tertiary level emergency department in Trinidad and Tobago.ParticipantsPatient and staff journeys in the emergency department were observed.ResultsSix broad categories were identified-1) ED organizational work processes, 2) ED design and layout, 3) material resources, 4) nursing staff levels, roles, skill mix and use 5) non-clinical ED staff and 6) external clinical and non-clinical departments. The study findings were combined with existing literature to produce a model of factors influencing ED patient flow. Barriers and facilitators to patient flow were highlighted.ConclusionThe knowledge gained may be used to strengthen the emergency care system in the local context. The model of ED patient flow may be used to systematically examine factors influencing patient flow, informing policy and practice. However, the study findings should be validated in other settings.Article summaryStrengths and limitations of this studyPrevious studies have been predominantly conducted in developed countries using quantitative methodsStrengthening emergency care systems is becoming a priority in developing countries but the Caribbean remains an under-represented region.This study explores ED patient flow in a developing Caribbean country using a multi-method qualitative design, primarily observational process mappingSingle observer used to collect dataSinge site may produce context specific findings
