Improving emergency department flow by introducing four interventions simultaneously. A quality improvement project

Abstract

Background: Emergency department (ED) crowding is a widespread issue with adverse effects on patient care and outcomes.

Local problem: ED crowding exacerbates wait times and compromises patient care, prompting opportunities for internal process improvement.

Method: Over one week, the ED flow project team implemented four interventions, including an additional triage station, to optimize patient flow. We compared triage times, length of stay, crowding levels, and patient experiences with two control periods.

Results: During peak hours, waiting times to triage decreased significantly with a median of 20 min (IQR 15-30) in the project week and 26 min (IQR 18-37) in the control weeks. Self-referrals decreased, while general practitioner referrals remained unchanged. Individual patient length of stay was unaffected, but crowding reduced notably during the project week. We found no difference in patient experiences between the periods.

Conclusion: The interventions contributed to reduced crowding and improved patient flow. The dedication of the ED flow project team and the ED nurses was crucial to these outcomes. An additional triage station during peak hours in the ED was established as a structural change.

Keywords: Crowding; Emergency Department; Length of stay; Patient Flow; Process improvement; Surge capacity.