Exploring delay points at the emergency department

Authors

DOI:

https://doi.org/10.29173/cjen158

Keywords:

Emergency department, length of stay, points of delay, patient experience

Abstract

Background

 The increasing time spent in the emergency department is becoming a global problem contributing to overcrowding. The increased length of stay in the emergency department can negatively affect patients' perception of care, contributes to high morbidity and mortality rates, and increased aggression towards staff. Therefore, understanding the delay points will help administrators and policy makers channel resources to the areas that require improvement.

Methods

This is a cross-sectional descriptive study to evaluate the delay points in the emergency department. The study was conducted at level IV community hospital in British Columbia. One hundred sixty-seven participants were recruited using a consecutive convenience sampling.

Results

The total sample size of this study was 167 and the age of the respondents ranged from 18-101 years. There were more females (50.9%) than males (47.9%) or queer individuals. The care point with the longest wait time was tests to physician reassessment (median time 65 minutes), followed by physician to Imaging (median time 52 minutes) and finally nurse to physician assessment (median time 45 minutes). Despite the prolonged length of stay in emergency department, most participants enjoyed the courtesy of staff (74.7%, good-very good) and 59.9% indicated that they would recommend this emergency department to others.

Conclusion

Tests and waiting for physician reassessments are important points in the patient journey in the emergency department that can prolong length of stay. Future studies are needed to determine whether various interventions such as point of care testing, utilizing the Lean Model and improving physician services can help reduce lengths of stay in the emergency department.

References

Abidova, A., da Silva, P. A., & Moreira, S. (2020). Predictors of patient satisfaction and perceived quality of healthcare in an emergency department in Portugal. Western Journal of Emergency Medicine, 21(2), 391–403. https://doi.org/105811/westjem.2019.9.44667

Ackroyd-Stolarz, S., Read Guernsey, J., Mackinnon, N, J., & Kovacs, G. (2011). The association between a prolonged stay in the emergency department and adverse events in older patients admitted to hospital: A retrospective cohort study. BMJ Quality & Safety, 20(7), 564–569. https://doi.org/10.1136/bmjqs.2009.034926

Asplin, B. R., Magid, D. J., Rhodes, K. V., Solberg, L. I., Lurie, N., & Camargo, C. A. (2003). A conceptual model of emergency department crowding. Annals of Emergency Medicine, 42(2), 173–180. https://doi.org/10.1067/mem.2003.302

Bonalumi, N. M., Bhattacharya, A., Edwards, C., Fasnacht, A., Mazzone, L., Stephens, K., Whiteman, K., & Swanson-Bierman, B. (2017). Impact of a planned workflow change: Super track improves quality and service for low-acuity patients at an inner-city hospital. Journal of Emergency Nursing, 43(2), 114–125. https://doi.org/10.1016/j.jen.2016.03.029

Boudreaux, E. D., Ary, R. D., Mandry, C. V., & McCabe, B. (2000). Determinants of patient satisfaction in a large, municipal ED: The role of demographic variables, visit characteristics, and patient perceptions. American Journal of Emergency Medicine, 18(4), 394–400.

Bullard, M. J., Villa-Roel, C., Bond, K., Vester, M., Holroyd, B. R., & Rowe, B. H., (2009). Tracking emergency department overcrowding in a tertiary care academic institution. Health, 12, 99–106.

Davenport, P. J., O’Connor, S. J., Szychowski, J. M., Landry, A. Y., & Hernandez, S. R. (2017). The relationship between emergency department wait times and inpatient satisfaction. Health Marketing Quarterly, 34(2), 97–112. https://doi-org.ezproxy.library.uvic.ca/10.1080/07359683.2017.1307066

Eitel, D. R., Rudkin, S. E., Malvehy, M. A., Killeen, J. P., & Pines, J. M. (2010). Improving service quality by understanding emergency department flow: A white paper and position statement prepared for the American Academy of Emergency Medicine. The Journal of Emergency Medicine, 38(1), 70–79. https://doi.org/10.1016/j.jemermed.2008.03.038

Goodman, A., Fleming, K., Markwick, N., Morrison, T., Lagimodiere, L., Kerr, T., & Western Aboriginal Harm Reduction Society. (2017). “They treated me like crap, and I know it was because I was Native”: The healthcare experiences of Aboriginal peoples living in Vancouver’s inner city. Social Science & Medicine (1982), 178, 87–94. https://doi.org/10.1016/j.socscimed.2017.01.053

Improta, G., Romano, M., Di Cicco, M. V., Ferraro, A., Borelli, A., Verdoliva, C., Triassic, M., & Cesarelli, M. (2018) Lean thinking to improve emergency department throughput at AORN Cardarelli hospital. BMC Health Services Research, 18(1), 914. https://doi.org/10.1186/s12913-018-3654-0

Kaur, D., Sambasivan, M., & Kumar, N. (2013). Effects of spiritual intelligence, emotional intelligence, psychological ownership and burnout on caring behaviour of nurses: A cross-sectional study. Journal of Clinical Nursing, 22(21–22), 3192–3202. https://doi.org/10.1111/jocn.12386

Legramante, M. J., Morciano, L., Lucaroni, F., Gilardi, F., Caredda, E., Pesaresi, A. Coscia, M., Orlando, S., Brandi, A., Giovagnoli, B., Di Lecce, N. V., Visconti, G., & Palombi, L. (2016). Frequent use of emergency departments by the elderly population when continuing care is not well established. PloS One, 11(12), e0165939. https://doi.org/10.1371/journal.pone.01655939

Mohanan, K., Kaur, S. D. K., Bhalla, A. (2010). Patient satisfaction regarding nursing care at emergency outpatient department in a tertiary care hospital. Journal of Mental Health and Human Behavior, 15(1), 54–58.

Rutman, L., Stone, K., Reid, J., Woodward, A. G., & Migita, R. (2015). Improving patient fow using Lean Methodology: An emergency medicine experience. Current Treatment Options in Pediatrics, 1, 359–371. https://doi.org/10.1007/s40746-015-0038-0

Shah, S., Patel, A., Rumoro, D., Hohmann, S., & Fulham, F. (2015). Managing patient expectations at emergency department triage. Patient Experience Journal, 2(2). https://doi.org/10.35680/2372-0247.1090

Sullivan, C., Staib, A., Khanna, S., Good, N. M., Boyle, J., Cattell, R., Heiniger, L., Griffin, B. R., Bell, A. J., Lind, J., & Scott, I. A. (2016). The National Emergency Access Target (NEAT) and the 4-hour rule: Time to review the target. The Medical Journal of Australia, 204(9), 354.

Thompson, D. A., Yarnold, P. R., Williams, D. R., & Adams, S. L. (1996). Effects of actual waiting time, perceived waiting time, information delivery, and expressive quality on patient satisfaction in the emergency department. Annals of Emergency Medicine, 28(6), 657–665.

Turpel-Lafond, M.E. (2020). In plain sight: Addressing Indigenous-specific racism and discrimination in BC health care, full report, November 2020. https://engage.gov.bc.ca/app/uploads/sites/613/2020/11/In-Plain-Sight-Full-Report.pdf

Van der Linden, M. C., Meester, B. E., & van der Linden, N. (2016). Emergency department crowding affects triage processes. International Emergency Nursing, 29, 27–31. https://doi.org/10.1016/j.ienj.2016.02.003

von Elm, E., Altman, D. G., Egger, M., Pocock, S. J., Gøtzsche, P. C., & Vandenbroucke, J. P. (2008). STROBE Initiative. The

Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies. Journal of Clinical Epidemiology, 61(4), 344-9. PMID: 18313558

Walker, K., Stephenson, M., Loupis, A., Ben-Meir, M., Joe, K., Stephenson, M., Lowthian, J., Yip, B., Wu, E., Hansen, K., Rosler, R., Buntine, P., & Hutton, J. (2021). Displaying emergency patient estimated wait times: A multi‐centre, qualitative study of patient, community, paramedic and health administrator perspectives. Emergency Medicine Australasia: EMA, 33(3), 425–433. https://doi-org.ezproxy.library.uvic.ca/10.1111/1742-6723.13640

Watson, J. (2006). Caring theory as an ethical guide to administrative and clinical practices. Nursing Administration Quarterly, 30(1), 48–55. doi.org: doi.org/10.1097/00006216-200601000-00008.

Watson, J. (1996). Watson’s theory of transpersonal caring. In: P. H. Walker & B. Newman (Eds.), Blueprint for use of nursing models (pp. 141–184). New York, NY: NLN Press.

Wiley, K. K. (2017). ED Nurses’ impact on quality and value. Journal of Emergency Nursing, 43(4). https://doi.org/10.1016/jen.2017.05.003

Yarmohammadian, M. H., Rezaei, F., Haghshenas, A., & Tavakoli, N. (2017). Overcrowding in emergency departments: A review of strategies to decrease future challenges. Journal of Research in Medical Sciences: The Official Journal of Isfahan University of Medical Sciences, 22, 23. https://doi.org/10.4103/1735-1995.200277

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Published

2024-04-18

How to Cite

Kayuni, J., Dordunoo, D., Mallidou, M., Mohan, M., & Marquard, P. (2024). Exploring delay points at the emergency department. Canadian Journal of Emergency Nursing, 47(1), 14–19. https://doi.org/10.29173/cjen158

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Peer Reviewed Articles