scholarly journals Improving the wait time to consultation at the emergency department

2018 ◽  
Vol 7 (1) ◽  
pp. e000131 ◽  
Author(s):  
Yuzeng Shen ◽  
Lin Hui Lee
Keyword(s):  
Emergency Department ◽  
Low Cost ◽  
Wait Time ◽  
Data Driven ◽  
Wait Times ◽  
Model Of Care ◽  
Care Model ◽  
Patient Load ◽  
Data Driven Approach ◽  
Team Based Care

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.

scholarly journals Estimating Wait Time and Passenger Load in a Saturated Metro Network: A Data-Driven Approach

2020 ◽  
Vol 2020 ◽  
pp. 1-17
Author(s):  
Hezhou Qu ◽  
Xiaoyue Xu ◽  
Steven Chien
Keyword(s):  
Joint Probability ◽  
Wait Time ◽  
Service Planning ◽  
Data Driven ◽  
Passenger Demand ◽  
Passenger Travel ◽  
Data Driven Approach ◽  
System Data ◽  
Transit Performance

The service quality of public transit, such as comfort and convenience, is an important factor influencing ridership and fare revenue, which also reflects the passengers’ perception to the transit performance. Passengers are frustrated while waiting to board a crowded train especially during the peak hours, while the fail-to-board (FtB) situation commonly exists. The service performance measures determined by deterministic passenger demand and service frequency cannot reflect the perceived service of passengers. With the automatic fare collection system data provided by Chengdu Metro, we develop a data-driven approach considering the joint probability of spatiotemporal passenger demand at stations based on posted train schedule to approximate passenger travel time (e.g., in-vehicle and out-of-vehicle times). It was found that the estimated wait time can reflect the actual situation as passengers FtB. The proposed modeling approach and analysis results would be useful and beneficial for transit providers to improve system performance and service planning.

scholarly journals A comparative study of patient characteristics, opinions, and outcomes, for patients who leave the emergency department before medical assessment

CJEM ◽  
2016 ◽  
Vol 19 (5) ◽  
pp. 347-354 ◽  
Author(s):  
Jacqueline Fraser ◽  
Paul Atkinson ◽  
Audra Gedmintas ◽  
Michael Howlett ◽  
Rose McCloskey ◽  
...  
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Performance Indicator ◽  
Medical Condition ◽  
Demographic Data ◽  
Family Doctor ◽  
Wait Time ◽  
Wait Times ◽  
Control Group ◽  
Fisher Exact Test

AbstractObjectiveThe emergency department (ED) left-without-being-seen (LWBS) rate is a performance indicator, although there is limited knowledge about why people leave, or whether they seek alternate care. We studied characteristics of ED LWBS patients to determine factors associated with LWBS.MethodsWe collected demographic data on LWBS patients at two urban hospitals. Sequential LWBS patients were contacted and surveyed using a standardized telephone survey. A matched group of patients who did not leave were also surveyed. Data were analysed using the Fisher exact test, chi-square test, and student t-test.ResultsThe LWBS group (n=1508) and control group (n=1504) were matched for sex, triage category, recorded wait times, employment and education, and having a family physician. LWBS patients were younger, more likely to present in the evening or at night, and lived closer to the hospital. A long wait time was the most cited reason for leaving (79%); concern about medical condition was the most common reason for staying (96%). Top responses for improved likelihood of waiting were shorter wait times (LWBS, 66%; control, 31%) and more information on wait times (41%; 23%). A majority in both groups felt that their condition was a true emergency (63%; 72%). LWBS patients were more likely to seek further health care (63% v. 28%; p<0.001) and sooner (median time 1 day v. 2-4 days; p=0.002). Among patients who felt that their condition was not a true emergency, the top reason for ED attendance was the inability to see their family doctor (62% in both groups).ConclusionLWBS patients had similar opinions, experiences, and expectations as control patients. The main reason for LWBS was waiting longer than expected. LWBS patients were more likely to seek further health care, and did so sooner. Patients wait because of concern about their health problem. Shorter wait times and improved communication may reduce the LWBS rate.

scholarly journals Optimizing Outpatient Phlebotomy Staffing: Tools to Assess Staffing Needs and Monitor Effectiveness

2014 ◽  
Vol 138 (7) ◽  
pp. 929-935 ◽  
Author(s):  
Aleksandar S. Mijailovic ◽  
Milenko J. Tanasijevic ◽  
Ellen M. Goonan ◽  
Rachel D. Le ◽  
Jonathan M. Baum ◽  
...  
Keyword(s):  
Health Care ◽  
Wait Time ◽  
Data Driven ◽  
Wait Times ◽  
Service Capacity ◽  
Staffing Levels ◽  
Number Of Patients ◽  
Patient Wait Time ◽  
Staffing Needs ◽  
Improve Patient

Context.—Short patient wait times are critical for patient satisfaction with outpatient phlebotomy services. Although increasing phlebotomy staffing is a direct way to improve wait times, it may not be feasible or appropriate in many settings, particularly in the context of current economic pressures in health care. Objective.—To effect sustainable reductions in patient wait times, we created a simple, data-driven tool to systematically optimize staffing across our 14 phlebotomy sites with varying patient populations, scope of service, capacity, and process workflows. Design.—We used staffing levels and patient venipuncture volumes to derive the estimated capacity, a parameter that helps predict the number of patients a location can accommodate per unit of time. We then used this parameter to determine whether a particular phlebotomy site was overstaffed, adequately staffed, or understaffed. Patient wait-time and satisfaction data were collected to assess the efficacy and accuracy of the staffing tool after implementing the staffing changes. Results.—In this article, we present the applications of our approach in 1 overstaffed and 2 understaffed phlebotomy sites. After staffing changes at previously understaffed sites, the percentage of patients waiting less than 10 minutes ranged from 88% to 100%. At our previously overstaffed site, we maintained our goal of 90% of patients waiting less than 10 minutes despite staffing reductions. All staffing changes were made using existing resources. Conclusions.—Used in conjunction with patient wait-time and satisfaction data, our outpatient phlebotomy staffing tool is an accurate and flexible way to assess capacity and to improve patient wait times.

scholarly journals Emergency Department wait time sharing: Do patients contribute to efficiency?

2017 ◽  
Vol 6 (4) ◽  
pp. 23
Author(s):  
Tom R. McDougal, Jr ◽  
Stephen J. O'Connor ◽  
Amy Y. Landry ◽  
Kristine R. Hearld
Keyword(s):  
Emergency Department ◽  
Performance Metrics ◽  
Wait Time ◽  
Ordinary Least Squares ◽  
Hospital Performance ◽  
Care Quality ◽  
Wait Times ◽  
Time Sharing ◽  
Patient Throughput ◽  
Reservation System

Objective: Inefficiency commonly results in overcrowding of the Emergency Department (ED) and is a problem for many hospitals. When a condition of overcrowding exists, it is often associated with lower patient satisfaction, lower care quality, and decreased financial position of the hospital. To improve patient throughput efficiency, hospitals use a variety of strategies including posting ED wait times on the hospital website and the use of ED reservation systems. This study investigates these two hospital strategies used to inform patients of anticipated wait times in the ED and their associations with patient throughput efficiency.Methods: The study employs bivariate and Ordinary Least Squares (OLS) regression models to explore the associations between ED efficiency, measured by time spent in the ED, and ED wait times posted on the hospital website (Wait Times on Website) and ED time efficiency and the use of ED reservation systems. The sample includes all 176 acute care hospitals with an ED located in Florida.Results: The results of this study support that posting ED wait times has a statistically significant association with time spent in the ED; however, we did not find an association between the use of a reservation system and time in the ED. Furthermore, the control variables of hospital licensed bed size, metropolitan location, percent of population without health insurance, and percent of population Medicaid eligible were found to have associations with time spent in the ED.Conclusions: This study supports that hospitals should inform patients of anticipated ED wait times. Methods to share wait times should include posting on the hospital website, billboards, or other means to increase the likelihood of informed patients. With anticipated wait time information, the patient has the opportunity to engage in rational decision making that will positively affect ED efficiency. Healthcare leaders, including hospital administrators and ED managers, are encouraged to identify and implement better ways to inform patients of hospital performance metrics to create the opportunity for greater patient decision engagement.

scholarly journals Lung cancer care trajectory at a Canadian centre: an evaluation of how wait times affect clinical outcomes

2017 ◽  
Vol 24 (5) ◽  
pp. 302 ◽  
Author(s):  
G. Kasymjanova ◽  
D. Small ◽  
V. Cohen ◽  
R.T. Jagoe ◽  
G. Batist ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Patient Outcomes ◽  
Cancer Care ◽  
Wait Time ◽  
Treatment Modalities ◽  
Wait Times ◽  
Model Of Care ◽  
Time Intervals ◽  
Lung Cancer Patients

Background Lung cancer continues to be one of the most common cancers in Canada, with approximately 28,400 new cases diagnosed each year. Although timely care can contribute substantially to quality of life for patients, it remains unclear whether it also improves patient outcomes. In this work, we used a set of quality indicators that aim to describe the quality of care in lung cancer patients. We assessed adherence with existing guidelines for timeliness of lung cancer care and concordance with existing standards of treatment, and we examined the association between timeliness of care and lung cancer survival.Methods Patients with lung cancer diagnosed between 2010 and 2015 were identified from the Pulmonary Division Lung Cancer Registry at our centre.Results We demonstrated that the interdisciplinary pulmonary oncology service successfully treated most of its patients within the recommended wait times. However, there is still work to be done to decrease variation in wait time. Our results demonstrate a significant association between wait time and survival, supporting the need for clinicians to optimize the patient care trajectory.Interpretation It would be helpful for Canadian clinicians treating patients with lung cancer to have wait time guidelines for all treatment modalities, together with standard definitions for all time intervals. Any reductions in wait times should be balanced against the need for thorough investigation before initiating treatment. We believe that our unique model of care leads to an acceleration of diagnostic steps. Avoiding any delay associated with referral to a medical oncologist for treatment could be an acceptable strategy with respect to reducing wait time.

scholarly journals MON-LB302 Evaluating the Impact of a New Intake Process for British Columbia Children’s Hospital Gender Clinic

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Danya A Fox ◽  
Mabel Tan ◽  
Robyn Lalani ◽  
Louanna Atkinson ◽  
Brenden Hursh ◽  
...  
Keyword(s):  
Clinical Pathway ◽  
Wait Time ◽  
Limited Resources ◽  
Wait Times ◽  
Model Of Care ◽  
Gnrh Analog ◽  
Average Wait Time ◽  
Physician Visits ◽  
New Model ◽  
The Impact

Abstract Our pediatric Gender Clinic is receiving a growing number of referrals, yet continues to operate with limited resources. To try to address this issue, a new clinical pathway was developed in 2017, which included an inter-professional assessment clinic run by nurses and social workers as the entry point for new referrals (known as ‘intake appointments’). These visits help to identify those youth who require urgent access to care (i.e. for imminent puberty), wayfinding to community supports and providers who can complete GnRH analog and hormone-readiness assessments, and information about potential medical interventions. The goals of this study were to (1) map out current processes, (2) evaluate wait times for patients referred in 2015-2016 (pre-intake) and 2018-2019 (post-intake), and (3) describe referral patterns and outcomes. Patients referred in 2017 were excluded, as this was a transitional year. In 2015-2016, 222 referrals were received, compared to 407 referrals in 2018-2019. Of the post-intake cohort, to date, 202/407 referrals have led to an intake appointment, of which 45 were via telehealth (a service not previously offered to families). Average wait time to physician visit was 171 days (range 10-1271; IQR 69-208) for patients in the pre-intake cohort, while the average wait time to intake appointment was 200 days (range 9-569, IQR 114-242) in the post-intake cohort. Wait time to physician visits cannot be assessed yet, due to the number of pending referrals. Fifty-four referrals were cancelled in the pre-intake, and 73 in the post-intake cohort. In both groups, the primary reason for cancellation was redirection by our team to other services (32% in both groups), and the second most common reason was cancellation by the family/no show to appointment (26% and 22% in the pre- and post-intake cohorts, respectively). Staffing resources and number of clinics per week have changed over the years, limiting our ability to attribute changes directly to the new clinical pathway. Moreover, most hormone-readiness assessments are completed by community providers. Therefore, wait times to physician visits partly reflect difficulty in accessing these community resources. However, using our new model of care, we have engaged with hundreds of patients and families within a similar time frame to the 2015-2016 cohort, despite an almost doubling of the number of referrals received by our clinic. Although these initial visits do not allow for initiation of medical therapy, they are a means to support patients and families through their gender journey. Moreover, the intake appointments have promoted inter-professional collaborative care, which is particularly beneficial in the face of limited resources. Thus, we believe this new model of care has led to improved quality of care for patients accessing our Gender Clinic.

scholarly journals Influence of publicly available online wait time data on emergency department choice in patients with noncritical complaints

CJEM ◽  
2012 ◽  
Vol 14 (04) ◽  
pp. 237-246 ◽  
Author(s):  
Amelia Yip ◽  
Shelley McLeod ◽  
Andrew McRae ◽  
Bin Xie
Keyword(s):  
Emergency Department ◽  
Patient Satisfaction ◽  
Public Awareness ◽  
Wait Time ◽  
Future Research ◽  
Wait Times ◽  
Time Data ◽  
Logistic Regression Models ◽  
Willingness To Use ◽  
Time Information

ABSTRACTObjectives:Increased emergency department (ED) wait times lead to more patients who leave without being seen and decreased patient satisfaction. Many EDs post estimated wait times either online or in the ED to guide patient expectations. The objectives of this study were to assess patients' awareness of online wait time data and to investigate patients' willingness to use this information when choosing between two academic EDs in London, Ontario.Methods:A prospective study was conducted over a 2-month period in a tertiary ED with online available wait times. Patients over 18 years of age assigned a Canadian Triage and Acuity Scale (CTAS) score of 3, 4, or 5 were approached by trained research assistants to complete a 15-item paper-based questionnaire. Multivariable logistic regression models were used to determine factors independently associated with the outcomes.Results:A total of 1,211 patients completed the survey. Of these, 109 (9%) were aware that ED wait time information was available on the Internet; 544 (45%) reported that they would use the available data to make a decision on which ED to visit, and 536 (44%) indicated that they were more likely to go to the ED with a shorter wait time. Age, gender, household income, education, and Internet access were not associated with awareness of online ED wait times. Participants less than 40 years of age were more likely to use online wait time information.Conclusion:There is low awareness of the availability of ED wait time data published online in the study locaton. Future research may include the delivery of a public awareness strategy for ED wait time data and a re-evaluation of ED use and patient satisfaction following this.

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