Optimizing Emergency Department Length of Stay and Quality of Care: A Quality Improvement Project.

Abstract

Background Patients' long length of stay (LOS) in the emergency department (ED) is a common measure of quality of care that could be a cause of increased morbidity and mortality. This quality improvement project (QIP) aimed to identify causes of long LOS and to improve common causes such as long consultation times. Methodology Over two months, three plan, do, study, and act (PDSA) cycles were conducted aiming to identify causes of long ED LOS and improve common causes that extended ED LOS beyond four hours. Additionally, the projectaimed to reduce the time taken from requesting a consultation from another specialty until it was completed and documented to an average of 60 minutes. Main interventions included raising awareness of staff and administration through video presentations, printed posters, direct contact, and optimizing the electronic health records system to audit performance. Results From PDSA cycle 1 through PDSA cycle 3, average consultation times decreased from 91 to 65 minutes. Common organization-related causes of long LOS included pending radiology or laboratory investigations, awaiting inpatient admission, and awaiting consultations from other specialties. Physician-related factors included delay in documentation likely resulting from heavy workload. Pending investigations and admissions were factors that could be amended with better administrative control. Conclusions A multifaceted approach that tackles physician-related and organization-related factors could be a necessity to improve LOS and the quality of care in the ED. Having staff and administration aware of targets and performance along with utilizing the electronic health records system to audit performance and increase efficiency are beneficial in improving the LOS in the ED.