Multimodal Quality Improvement Intervention With Dedicated Patient Flow Manager to Reduce Emergency Department Length of Stay and Occupancy: Interrupted Time Series Analysis

Abstract

IntroductionCrowding in the emergency department is a problem worldwide that can affect patient safety and clinical outcomes. The aim of this project was to evaluate a multimodal quality improvement intervention with a new patient flow manager to reduce ED length of stay and ED bed occupancy. MethodsThis single-site interrupted time-series analysis study was conducted in a tertiary hospital emergency department in South Korea. Interventions for a novel system load-balancing approach included a data-driven patient flow tracking informatics system, adding medical specialists, point-of-care creatinine testing (when required before diagnostic imaging) with dedicated imaging test slots for emergency patients, and introducing patient flow managers. Records of adult patients visiting the emergency department from January 2016 to March 2020 were included. Outcomes were ED length of stay and ED bed occupancy. Regression discontinuity analysis of an interrupted time series was used adjusting for seasonality and the number of patients per staff. ResultsA total of 46,494 patients in the preintervention period and 151,802 patients in the postintervention period were included. After the intervention, ED length of stay decreased by 4.07 hours, whereas the slope indicated a return to preintervention levels over time. Monthly average ED bed occupancy decreased by 34.6%, and the slope remained consistent over time. DiscussionThe multimodal quality improvement intervention that included a patient flow manager was an effective intervention to reduce the ED length of stay and the ED bed occupancy at the study site. The change for length of stay may not sustain over time without further intervention.