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. 2024 Jul 8;5(4):e13234.
doi: 10.1002/emp2.13234. eCollection 2024 Aug.

Quality improvement in the era of boarding and burnout: A postpandemic blueprint

Hope Schwartz  1 , William Huen  2 , Hemal K Kanzaria  3 , Christopher R Peabody  3
Affiliations

Quality improvement in the era of boarding and burnout: A postpandemic blueprint

Hope Schwartz et al. J Am Coll Emerg Physicians Open. .

Abstract

The COVID-19 pandemic led to unprecedented challenges to healthcare quality in the emergency department, including directly impacting quality metrics and worsening barriers to the quality improvement process such as burnout, staff turnover, and boarding. We aimed to develop a blueprint for postpandemic quality improvement to address these specific barriers, focused on prioritizing frontline staff engagement from idea generation to implementation and assessment. Drawing from teamwork literature, we constructed a process that emphasized egalitarian conversations, psychological safety, and creating an environment where staff could feel heard at every step of the process. We applied this blueprint to improving rates of patients who leave without being seen and achieved a four percentage point reduction (9% vs. 5%, p < 0.001), with high rates of staff satisfaction with the process. We conclude that while postpandemic quality improvement presents significant challenges, we can rise to meet those challenges by adapting existing quality improvement processes to increase frontline staff engagement.

Keywords: COVID‐19; burnout; operations; quality; triage; wait times.

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Conflict of interest statement

Christopher Peabody is a consultant for FujiFilm and SonoSite on unrelated projects. On work unrelated to the current submission, Dr. Kanzaria's salary is supported by a grant from the Benioff Homelessness and Housing Initiative, University of California, San Francisco, CA, and he works as an advisor for Amae Health, Inc. All other authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Project timeline for postpandemic, staff‐engaged quality improvement process. PICK signifies “Possible, Implement, Challenge, Kill” chart, a commonly used quality improvement framework to evaluate the feasibility and efficacy of potential interventions.
FIGURE 2
FIGURE 2
Value Stream Map (VSM) displaying total time at each step of emergency department (ED) visit. “Wait Time” indicates time between steps, while “Cycle Time” indicates time taken during each step. Triage wait time, defined as the time from triage end to CareStart medical screening evaluation (MSE), is highlighted in red. RN signifies registered nurse.
FIGURE 3
FIGURE 3
Thematic analysis of interventions proposed by frontline staff.
FIGURE 4
FIGURE 4
Total patient encounters and left without being seen (LWBS) rate by month, Jan. 2022–Jan. 2024.
FIGURE 5
FIGURE 5
Survey results from triage improvement workshop participants (n = 12).
See this image and copyright information in PMC

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References

    1. Lastinger LM, Alvarez CR, Kofman A, et al. Continued increases in the incidence of healthcare‐associated infection (HAI) during the second year of the coronavirus disease 2019 (COVID‐19) pandemic. Infect Control Hosp Epidemiol. 2023;44(6):997‐1001. doi:10.1017/ice.2022.116 - DOI - PMC - PubMed
    1. Kelen GD, Wolfe R, D'Onofrio G, et al. Emergency department crowding: the canary in the health care system. Catal Non‐Issue Content. 2021;2(5). doi:10.1056/CAT.21.0217 - DOI
    1. Kanzaria HK, Cooper RJ. The unspoken inequities of our boarding crisis. Ann Emerg Med. 2023;82(3):255‐257. doi:10.1016/j.annemergmed.2023.02.004 - DOI - PubMed
    1. Lucero A, Sokol K, Hyun J, et al. Worsening of emergency department length of stay during the COVID‐19 pandemic. J Am Coll Emerg Physicians Open. 2021;2(3):e12489. doi:10.1002/emp2.12489 - DOI - PMC - PubMed
    1. Oskvarek JJ, Zocchi MS, Black BS, et al. Emergency department volume, severity, and crowding since the onset of the coronavirus disease 2019 pandemic. Ann Emerg Med. 2023;82:650‐660. doi:10.1016/j.annemergmed.2023.07.024 - DOI - PubMed