- Title
- Delayed flow is a risk to patient safety: a mixed method analysis of emergency department patient flow
- Creator
- Pryce, Alex; Unwin, Maria; Kinsman, Leigh; McCann, Damhnat
- Relation
- International Emergency Nursing Vol. 54, Issue January, no. 100956
- Publisher Link
- http://dx.doi.org/10.1016/j.ienj.2020.100956
- Publisher
- Elsevier
- Resource Type
- journal article
- Date
- 2021
- Description
- 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.
- Subject
- emergency service; hospital; SDG 3; length of stay; crowding; triage; patient flow; hallway care; patient safety; Sustainable Development Goals; SDG 7
- Identifier
- http://hdl.handle.net/1959.13/1425555
- Identifier
- uon:38268
- Identifier
- ISSN:1755-599X
- Language
- eng
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Goal 3: Good Health and Well-Being
Goal 7: Ensure access to affordable, reliable, sustainable and modern energy
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