scholarly journals Waiting times in emergency departments: exploring the factors associated with longer patient waits for emergency care in England using routinely collected daily data

2020 ◽  
pp. emermed-2019-208849
Author(s):  
Steven Paling ◽  
Jennifer Lambert ◽  
Jasper Clouting ◽  
Júlia González-Esquerré ◽  
Toby Auterson
Keyword(s):  
Emergency Departments ◽  
Fixed Effects ◽  
Patient Flow ◽  
Waiting Times ◽  
Healthcare Providers ◽  
Ordinary Least Squares ◽  
Hospital Length Of Stay ◽  
Bed Occupancy ◽  
Point Change ◽  
Factors Associated

BackgroundLong lengths of stay (also called waiting times) in emergency departments (EDs) are associated with higher patient mortality and worse outcomes.ObjectiveTo add to the literature using high-frequency data from a large number of hospitals to analyse factors associated with long waiting times, including exploring non-linearities for 'tipping points'.MethodsMultivariate ordinary least squares regressions with fixed effects were used to analyse factors associated with the proportion of patients in EDs in England waiting more than 4 hours to be seen, treated and admitted or discharged. Daily situation reports (Sitrep), hospital episode statistics and electronic staffing records data over 90 days between December 2016 and February 2017 were used for all 138 English NHS healthcare providers with a major ED.ResultsHigher inpatient bed occupancy was correlated with longer ED waiting times, with a non-linear association. In a full hospital, with 100% bed occupancy, the proportion of patients who remained in the ED for more than 4 hours was 9 percentage points higher (95% CI 7.5% to 11.1%) than with an 85% occupancy level. For each percentage point change in the following factors, the proportion of ED stays over 4 hours also increased: more inpatients with hospital length of stay over 21 days (0.07%, 95% CI 0.008% to 0.13%); higher emergency admissions (0.08%, 95% CI 0.06% to 0.10%); and lower discharges relative to admissions on the same day (0.04%, 95% CI 0.02% to 0.06%), the following day (0.05%, 95% CI 0.03% to 0.06%) and at 2 days (0.05%, 95% CI 0.04% to 0.07%).ConclusionsThese results suggest that tackling patient flow and capacity in the wider hospital, particularly very high bed occupancy levels and patient discharge, is important to reduce ED waiting times and improve patient outcomes.

scholarly journals Why are there long waits at English emergency departments?

2019 ◽  
Vol 21 (2) ◽  
pp. 209-218 ◽  
Author(s):  
James Gaughan ◽  
Panagiotis Kasteridis ◽  
Anne Mason ◽  
Andrew Street
Keyword(s):  
Emergency Departments ◽  
Fixed Effects ◽  
Waiting Times ◽  
Poisson Model ◽  
Bed Occupancy ◽  
Term Care ◽  
Delayed Discharges ◽  
A Minor ◽  
The Impact

Abstract A core performance target for the English National Health Service (NHS) concerns waiting times at Emergency Departments (EDs), with the aim of minimising long waits. We investigate the drivers of long waits. We analyse weekly data for all major EDs in England from April 2011 to March 2016. A Poisson model with ED fixed effects is used to explore the impact on long (> 4 h) waits of variations in demand (population need and patient case-mix) and supply (emergency physicians, introduction of a Minor Injury Unit (MIU), inpatient bed occupancy, delayed discharges and long-term care). We assess overall ED waits and waits on a trolley (gurney) before admission. We also investigate variation in performance among EDs. The rate of long overall waits is higher in EDs serving older patients (4.2%), where a higher proportion of attendees leave without being treated (15.1%), in EDs with a higher death rate (3.3%) and in those located in hospitals with greater bed occupancy (1.5%). These factors are also significantly associated with higher rates of long trolley waits. The introduction of a co-located MIU is significantly and positively associated with long overall waits, but not with trolley waits. There is substantial variation in waits among EDs that cannot be explained by observed demand and supply characteristics. The drivers of long waits are only partially understood but addressing them is likely to require a multi-faceted approach. EDs with high rates of unexplained long waits would repay further investigation to ascertain how they might improve.

scholarly journals Modeling, Assessment and Design of an Emergency Department of a Public Hospital through Discrete-Event Simulation

2021 ◽  
Vol 11 (2) ◽  
pp. 805
Author(s):  
Alexandre Castanheira-Pinto ◽  
Bruno S. Gonçalves ◽  
Rui M. Lima ◽  
José Dinis-Carvalho
Keyword(s):  
Emergency Department ◽  
Simulation Model ◽  
Emergency Departments ◽  
Patient Flow ◽  
Waiting Times ◽  
Discrete Event ◽  
Analytical Description ◽  
Northern Region ◽  
Optimized Design ◽  
Initial State

Emergency departments in hospitals are having many difficulties in achieving the performance levels required by health regulators and society. The waiting times as well as the total throughput time are examples of performance indicators that emergency departments need to improve in order to provide a better service to the community. To achieve improvement of performance, the present paper shows a methodology to assist the design process of an emergency department using simulation techniques. In this study, the emergency department of a hospital located in the northern region of Portugal was considered to test the proposed simulation technique. The emergency department initial state was assessed, in terms of patient flow, as well as the human resources needed at every stage of the service. In order to understand in depth the process that a patient goes through during an emergency episode, a comprehensive study was performed on the hospital database. This allowed the analytical description of an emergency episode, which was further used as an input to the simulation model. After developing the simulation model with the information obtained by the hospital’s database, a validation stage was performed. Finally, in order to achieve an optimized design for the emergency department several variant scenarios were considered and evaluated. This methodology proved to be very useful in determining an optimized operation for complex, and non-linear systems.

scholarly journals 6 Improving Patient Flow in a Multi-Specialty Assessment Area by Introducing Referral Pathways for Orthopaedics and Plastic Surgery during the COVID-19 Pandemic

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
G Gordon ◽  
A Fadulelmola ◽  
S Scott
Keyword(s):  
Plastic Surgery ◽  
Emergency Departments ◽  
Patient Flow ◽  
Waiting Times ◽  
Hospital Setting ◽  
District General Hospital ◽  
Improvement Project ◽  
Specialty Area ◽  
Referral Criteria ◽  
Orthopaedic Patients

Abstract Introduction The COVID-19 pandemic has seen fundamental organisational changes to emergency departments internationally. Specialties throughout the hospital setting have been asked to change their working practice, often with the aim of adapting to new processes in emergency departments. Early in the pandemic, the orthopaedic team at one district general hospital were required to provide 24/7 onsite cover in a multi-specialty area. Confusion over the referral pathways of two specialties (orthopaedics and plastic surgery) led to increase waiting times, constrained patient flow and poor patient and staff satisfaction. Method This quality improvement project occurred over three cycles of data collection and intervention over a two-month period. A novel referral pathway was developed and implemented after discussion with consultants in orthopaedics, plastics, and emergency medicine. Interventions included staff teaching, clarifying of roles at morning meetings and the deployment of posters. Results In cycle 1, 39% of orthopaedic referrals were inappropriately referred. By cycle 3, 0% of orthopaedic patients were inappropriately referred. Average time in department for patients referred to orthopaedics improved from 124 minutes to 88 minutes. Staff reported increased satisfaction, with appreciation for the clarification on referral criteria. Conclusions This QUIP demonstrates how simple interventions during times of crisis can solve complex organisational issues.

scholarly journals Applications of RFID Systems in Healthcare Management: A Simulation for Emergency Department

2019 ◽  
Vol 8 (10) ◽  
pp. 786-792
Keyword(s):  
Patient Satisfaction ◽  
Emergency Departments ◽  
Medical Staff ◽  
Improve Patient Safety ◽  
Patient Flow ◽  
Tracking System ◽  
Waiting Times ◽  
Complex Structure ◽  
Healthcare Management ◽  
Heart Attacks

Emergency Departments are the most complex and busiest locations for patient flow in hospitals. Treatment of acute diseases, accidental injuries, heart attacks or different medical applications are performed in these centers. At this point, patients should receive effective treatments as soon as possible. Additionally, they can include in medical procedures such as triage, registration, treatment, transfer or hospitalization when they apply of this departments. There are many problems in these services due to their complex structure. For instance; long waiting times, leaving the hospital without excuse or without payment, lack of bed or medical staff, long staying times. For these reasons, patient cares and treatments will be affected. It is thought that using of RFID Technology will be expanded in the Emergency Departments that it may decrease long waiting times, improve the quality of treatment processes and increase patient satisfaction also. In this study, it is aimed to improve patient safety and quality with sustainable tracking system. In addition, a real-time warning mechanism will be created by determining the number of optimum medical staff due to this technology. As a result, length of stay of the patients will be reduced and patient satisfaction will be increased in Emergency Departments.

Integrated Lean Six Sigma Approach for Patient Flow Improvement in Hospital Emergency Department

2013 ◽  
Vol 834-836 ◽  
pp. 1893-1902 ◽  
Author(s):  
Ali Al Owad ◽  
M.A. Karim ◽  
Lin Ma
Keyword(s):  
Emergency Department ◽  
Six Sigma ◽  
Emergency Departments ◽  
Patient Flow ◽  
Healthcare Providers ◽  
Patient Treatment ◽  
Smooth Flow ◽  
Management Concepts ◽  
Six Sigma Methodology ◽  
Six Sigma Approach

Because of increased competition between healthcare providers, higher customer expectations, stringent checks on insurance payments and new government regulations, it has become vital for healthcare organisations to enhance the quality of the care they provide, to increase efficiency, and to improve the cost effectiveness of their services. Consequently, a number of quality management concepts and tools are employed in the healthcare domain to achieve the most efficient ways of using time, manpower, space and other resources. Emergency departments are designed to provide a high-quality medical service with immediate availability of resources to those in need of emergency care. The challenge of maintaining a smooth flow of patients in emergency departments is a global problem. This study attempts to improve the patient flow in emergency departments by considering Lean techniques and Six Sigma methodology in a comprehensive conceptual framework. The proposed research will develop a systematic approach through integration of Lean techniques with Six Sigma methodology to improve patient flow in emergency departments. The results reported in this paper are based on a standard questionnaire survey of 350 patients in the Emergency Department of Aseer Central Hospital in Saudi Arabia. The results of the study led us to determine the most significant variables affecting patient satisfaction with patient flow, including waiting time during patient treatment in the emergency department; effectiveness of the system when dealing with the patients complaints; and the layout of the emergency department. The proposed model will be developed within a performance evaluation metric based on these critical variables, to be evaluated in future work within fuzzy logic for continuous quality improvement.

scholarly journals Performance analysis in emergency departments: a data-driven approach

2018 ◽  
Vol 22 (2) ◽  
pp. 130-145 ◽  
Author(s):  
Alessandro Stefanini ◽  
Davide Aloini ◽  
Elisabetta Benevento ◽  
Riccardo Dulmin ◽  
Valeria Mininno
Keyword(s):  
Real Time ◽  
Emergency Departments ◽  
Process Mining ◽  
Patient Flow ◽  
Waiting Times ◽  
Simulation Models ◽  
Data Driven ◽  
Content Type ◽  
Actual Patient ◽  
Data Driven Approach

PurposeThis paper aims to investigate the process performances in Emergency Departments (EDs) with a novel data-driven approach, permitting to discover the entire patient-flow, deploy the performances in term of time and resources on the activities and flows and identify process deviations and critical bottlenecks. Moreover, the use of this methodology in real time might dynamically provide a picture of the current situation inside the ED in term of waiting times, crowding, resources, etc., supporting the management of patient demand and resources in real time.Design/methodology/approachThe proposed methodology exploits the process-mining techniques. Starting from the event data inside the hospital information systems, it permits automatically to extract the patient-flows, to evaluate the process performances, to detect process exceptions and to identify the deviations between the expected and the actual results.FindingsThe application of the proposed method to a real ED revealed being valuable to discover the actual patient-flow, measure the performances of each activity with respect to the predefined targets and compare different operating situations.Practical implicationsStarting from the results provided by this system, hospital managers may explore the root causes of deviations, identify areas for improvements and hypothesize improvement actions. Finally, process-mining outputs may provide useful information for creating simulation models to test and compare alternative ED operational scenarios.Originality/valueThis study responds to the need of novel approaches for monitoring and evaluating processes performances in the EDs. The novelty of this data-driven approach is the opportunity to timely connect performances, patient-flows and activities.

The antecedents of corporate social and environmental responsibility discourse in Pakistan: Multiple theoretical perspectives

2019 ◽  
Author(s):  
Muhammad Farhan Basheer ◽  
Saqib Muneer ◽  
Muhammad Atif ◽  
Zubair Ahmad
Keyword(s):  
Institutional Theory ◽  
Least Squares ◽  
Agency Theory ◽  
Stakeholder Theory ◽  
Fixed Effects ◽  
Ordinary Least Squares ◽  
Environmental Responsibility ◽  
Legitimacy Theory ◽  
Discourse Practices ◽  
Corporate Social

The primary purpose of the study is to explore the antecedents of corporate social and environmental responsibilities discourse practices in Pakistan. The industry sensitivity, government shareholding, block holder ownership, print media coverage, environmental monitoring programs, and strategic posture are examined as antecedents of corporate social and environmental responsibility practices. A multidimensional theoretical perspective namely stakeholder theory (ST), institutional theory (IT), agency theory (PAT), and legitimacy theory (LT) is used to conceptualize the phenomena. All the four of perspective theories (positive accounting theory, legitimacy theory, stakeholder theory, and institutional theory) claim that there are ‘pressures’ that impact the organization. How much ‘pressures’ are recognized, managed or satisfied differs from one perspective of theory to the other. To estimate the data, this study uses three sets of panel data models, i.e., the pooled ordinary least squares model (POLS) or constant coefficients model, fixed effects (FEM or least squares dummy variable/LSDV model) and random-effects models. The final sample is comprising of 173 firms over eight years from 2011 to 2017. The firms listed in PSX are included in the sample. Overall the findings of the study have shown agreement with the proposed results. However, the study has provided more support to the institutional theory and stakeholder theory. Keywords: Corporate Social Responsibility, Stakeholders Theory, Agency Theory, Pakistan

scholarly journals Association of Emergency Department Waiting Times With Patient Experience in Admitted and Discharged Patients

2021 ◽  
Vol 8 ◽  
pp. 237437352110114
Author(s):  
Andrew Nyce ◽  
Snehal Gandhi ◽  
Brian Freeze ◽  
Joshua Bosire ◽  
Terry Ricca ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Patient Experience ◽  
Waiting Times ◽  
Hospital Length ◽  
Short Length ◽  
Hospital Length Of Stay ◽  
Patient’S Experience ◽  
Discharged Patients ◽  
The Impact

Prolonged waiting times are associated with worse patient experience in patients discharged from the emergency department (ED). However, it is unclear which component of the waiting times is most impactful to the patient experience and the impact on hospitalized patients. We performed a retrospective analysis of ED patients between July 2018 and March 30, 2020. In all, 3278 patients were included: 1477 patients were discharged from the ED, and 1680 were admitted. Discharged patients had a longer door-to-first provider and door-to-doctor time, but a shorter doctor-to-disposition, disposition-to-departure, and total ED time when compared to admitted patients. Some, but not all, components of waiting times were significantly higher in patients with suboptimal experience (<100th percentile). Prolonged door-to-doctor time was significantly associated with worse patient experience in discharged patients and in patients with hospital length of stay ≤4 days. Prolonged ED waiting times were significantly associated with worse patient experience in patients who were discharged from the ED and in inpatients with short length of stay. Door-to-doctor time seems to have the highest impact on the patient’s experience of these 2 groups.

scholarly journals Trajectories of Depressive Symptoms and Anxiety during Pregnancy and Associations with Pregnancy Stress

2021 ◽  
Vol 18 (5) ◽  
pp. 2733 ◽  
Author(s):  
Hyejung Lee ◽  
Ki-Eun Kim ◽  
Mi-Young Kim ◽  
Chang Gi Park ◽  
Jung Yeol Han ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Pregnant Women ◽  
Healthcare Providers ◽  
Sociodemographic Factors ◽  
Survey Questionnaire ◽  
Emotional Status ◽  
Factors Associated ◽  
Latent Trajectory ◽  
Logistic Regressions ◽  
Health Hospital

The purposes of this study were to investigate the trajectory groups of depressive symptoms and anxiety in women during pregnancy and to identify the factors associated with those groups. Participants were recruited from the outpatient clinic of a women’s health hospital in Seoul, Korea. Pregnant women (n = 136) completed a survey questionnaire that included questions on depressive symptoms, anxiety, and pregnancy stress; additionally, their saliva was tested for cortisol hormone levels three times during their pregnancies. The group-based trajectory modeling approach was used to identify latent trajectory groups. Ordinal logistic regressions were used to explore the association of latent trajectory groups with sociodemographic factors and pregnancy stress. Three trajectory groups of depressive symptoms were identified: low-stable (70%), moderate-stable (25%), and increased (5%). Four trajectory groups of anxiety were identified: very low-stable (10%), low-stable (67%), moderate-stable (18%), and high-stable (5%). The only factor associated with both the depressive symptoms and anxiety trajectory groups was pregnancy stress (p < 0.001). Most participants showed stable emotional status; however, some participants experienced higher levels of depressive symptoms and anxiety related to higher pregnancy stress. These pregnant women may need additional care from healthcare providers to promote their wellbeing during pregnancy.

Principles of capacity management, applied in the mental health context

2018 ◽  
Vol 42 (4) ◽  
pp. 438
Author(s):  
Kathryn Zeitz ◽  
Darryl Watson
Keyword(s):  
Mental Health ◽  
Mental Health Problems ◽  
Average Length ◽  
Patient Flow ◽  
Waiting Times ◽  
Capacity Management ◽  
Mental Health Setting ◽  
Mental Health Consumer ◽  
Mental Health Consumers ◽  
Flow Improvement

Objective The aim of the paper was to describe a suite of capacity management principles that have been applied in the mental health setting that resulted in a significant reduction in time spent in two emergency departments (ED) and improved throughput. Methods The project consisted of a multifocal change approach over three phases that included: (1) the implementation of a suite of fundamental capacity management activities led by the service and clinical director; (2) a targeted Winter Demand Plan supported by McKinsey and Co.; and (3) a sustainability of change phase. Descriptive statistics was used to analyse the performance data that was collected through-out the project. Results This capacity management project has resulted in sustained patient flow improvement. There was a reduction in the average length of stay (LOS) in the ED for consumers with mental health presentations to the ED. At the commencement of the project, in July 2014, the average LOS was 20.5 h compared with 8.5 h in December 2015 post the sustainability phase. In July 2014, the percentage of consumers staying longer than 24 h was 26% (n = 112); in November and December 2015, this had reduced to 6% and 7 5% respectively (less than one consumer per day). Conclusion Improving patient flow is multifactorial. Increased attendances in public EDs by people with mental health problems and the lengthening boarding in the ED affect the overall ED throughput. Key strategies to improve mental health consumer flow need to focus on engagement, leadership, embedding fundamentals, managing and target setting. What is known about the topic? Improving patient flow in the acute sector is an emerging topic in the health literature in response to increasing pressures of access block in EDs. What does this paper add? This paper describes the application of a suite of patient flow improvement principles that were applied in the mental health setting that significantly reduced the waiting time for consumers in two EDs. What are the implications for practitioners? No single improvement will reduce access block in the ED for mental health consumers. Reductions in waiting times require a concerted, multifocal approach across all components of the acute mental health journey.

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