Pryce, A and Unwin, M and Kinsman, D and McCann, D, Delayed flow is a risk to patient safety: A mixed method analysis of emergency department patient flow, International Emergency Nursing, 54 pp. 1-9. ISSN 1755-599X (2021) [Refereed Article]
Copyright 2020 Crown Copyright
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.
|Item Type:||Refereed Article|
|Keywords:||crowding, emergency service, hospital, hallway care, length of stay, patient flow, patient safety, triage|
|Research Division:||Biomedical and Clinical Sciences|
|Research Group:||Clinical sciences|
|Research Field:||Emergency medicine|
|Objective Group:||Provision of health and support services|
|Objective Field:||Urgent and critical care, and emergency medicine|
|UTAS Author:||Unwin, M (Ms Maria Unwin)|
|UTAS Author:||Kinsman, D (Professor Leigh Kinsman)|
|UTAS Author:||McCann, D (Ms Damhnat McCann)|
|Web of Science® Times Cited:||2|
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