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Delayed flow is a risk to patient safety: A mixed method analysis of emergency department patient flow

Version 2 2024-09-18, 23:35
Version 1 2023-05-21, 02:43
journal contribution
posted on 2023-05-21, 02:43 authored by Pryce, A, Maria UnwinMaria Unwin, Leigh Kinsman, Damhnat McCannDamhnat McCann

Introduction: Increasing emergency department (ED) demand and crowding has heightened focus on the need for better understanding of patient flow.

Aim: This study aimed to identify input, throughput and output factors contributing to ED patient flow bottlenecks and extended ED length of stay (EDLOS).

Method: Concurrent nested mixed method study based on retrospective analysis of attendance data, patient flow observational data and a focus group in an Australian regional ED.

Results: Analysis of 89 013 ED presentations identified increased EDLOS, particularly for patients requiring admission. Mapping of 382 patient journeys identified delays in time to triage assessment (0-39 mins) and extended waiting room stays (0-348 mins). High proportions of patients received care outside ED cubicles. Four qualitative themes emerged: coping under pressure, compromising care and safety, makeshift spaces, and makeshift roles.

Conclusion: Three key findings emerged: i) hidden waits such as extended triage-queuing occur during the input phase; ii) makeshift spaces are frequently used to assess and treat patients during times of crowding; and iii) access block has an adverse effect on output flow. Data suggests arrival numbers may not be a key predictor of EDLOS. This research contributes to our understanding of ED crowding and patient flow, informing service delivery and planning.

History

Publication title

International Emergency Nursing

Volume

54

Pagination

1-9

ISSN

1755-599X

Department/School

Menzies Institute for Medical Research

Publisher

Elsevier

Place of publication

United Kingdom

Rights statement

Copyright 2020 Crown Copyright

Repository Status

  • Restricted

Socio-economic Objectives

Urgent and critical care, and emergency medicine

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