Abstract
IntroductionCanadian emergency departments (ED) are struggling to provide timely emergency care. Very few studies have assessed attempts to improve ED patient flow in the rural context. We assessed the impact of SurgeCon, an ED patient-management protocol, on total patient visits, patients who left without being seen (LWBS), length of stay for departed patients (LOSDep), and physician initial assessment time (PIA) in a rural community hospital ED.MethodsWe implemented a set of commonly used methods for increasing ED efficiency with an innovative approach over 45 months. Our intervention involved seven parts comprised of an external review, Lean training, fast track implementation, patient-centeredness approach, door-to-doctor approach, performance reporting, and an action-based surge capacity protocol. We measured key performance indicators including total patient visits (count), PIA (minutes), LWBS (percentage), and LOSDep (minutes) before and after the SurgeCon intervention. We also performed an interrupted time series (ITS) analysis.ResultsDuring the study period, 80,709 people visited the ED. PIA decreased from 104.3 (±9.9) minutes to 42.2 (±8.1) minutes, LOSDep decreased from 199.4 (±16.8) minutes to 134.4(±14.5) minutes, and LWBS decreased from 12.1% (±2.2) to 4.6% (±1.7) despite a 25.7% increase in patient volume between pre-intervention and post-intervention stages. The ITS analysis revealed a significant level change in PIA – 19.8 minutes (p<0.01), and LWBS – 3.8% (0.02), respectively. The change over time decreased by 2.7 minutes/month (p< 0.001), 3.0 minutes/month (p<0.001) and 0.4%/month (p<0.001) for PIA, LOSDep, and LWBS, after the intervention.ConclusionSurgeCon improved the key wait-time metrics in a rural ED in a country where average wait times continue to rise. The SurgeCon platform has the potential to improve ED efficiency in community hospitals with limited resources.
Highlights
Canadian emergency departments (ED) are struggling to provide timely emergency care
physician initial assessment time (PIA) decreased from 104.3 (±9.9) minutes to 42.2 (±8.1) minutes, length of stay for departed patients (LOSDep) decreased from 199.4 (±16.8) minutes to 134.4(±14.5) minutes, and left without being seen (LWBS) decreased from 12.1% (±2.2) to 4.6% (±1.7) despite a 25.7% increase in patient volume between pre-intervention and post-intervention stages
In this 45-month study PIA decreased from a mean of 104.3 minutes (±9.9 standard deviations) to 42.2 (±8.1) minutes, LOSDep decreased from 199.4 (±16.8) minutes to 134.4(±14.5) minutes, and LWBS decreased from 12.1% (±2.2) to 4.6% (±1.7)
Summary
Canadian emergency departments (ED) are struggling to provide timely emergency care. Very few studies have assessed attempts to improve ED patient flow in the rural context. SurgeCon: Priming a Community ED for Patient Flow Management and resource pressures,[3] loss of full-care community providers,[4] and aging populations,[5] Canadian EDs are grappling with some of the longest wait times compared to peer industrialized countries.[6] The Newfoundland and Labrador (NL) Department of Health and Community Services has referred to EDs as the “front door” to the province’s healthcare system.[7] After missing its own wait time benchmarks in 2016,8 NL’s Eastern Regional Health Authority joined the chorus of emergency care providers across Canada hunting for a solution to crowded ED care.[7,9,10,11,12,13] Large-scale process improvement is effective at urban facilities,[14,15] but NL is predominately rural[16] with many small EDs facing crowding,[17] increasing hospital occupancy rates,[18] and restrictive department sizes.[19]
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