eCite Digital Repository

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


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 Statement

Copyright 2020 Crown Copyright

DOI: doi:10.1016/j.ienj.2020.100956


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 Details

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 Division:Health
Objective Group:Provision of health and support services
Objective Field:Urgent and critical care, and emergency medicine
UTAS Author:Unwin, M (Dr Maria Unwin)
UTAS Author:Kinsman, D (Professor Leigh Kinsman)
UTAS Author:McCann, D (Ms Damhnat McCann)
ID Code:146769
Year Published:2021
Web of Science® Times Cited:3
Deposited By:Nursing
Deposited On:2021-09-24
Last Modified:2021-11-24

Repository Staff Only: item control page