Goal-Driven Timed Target Workflow: Optimizing the Workflow for Emergency Department to Inpatient Admission

Abstract

Introduction: The emergency department inpatient admission process is a key contributor to throughput delays and can indicate facility-wide inefficiencies. The purpose of this study was to examine the effectiveness of an enhanced goal-driven timed target emergency department inpatient workflow process, with a specific focus on timing, successful communication, and escalation.

Methods: The researchers used a 9-month time series quasi-experimental design to examine 7478 emergency department inpatient admissions data from October 2022 to June 2023; a new workflow was introduced in November 2022.

Results: A Kruskal-Wallis H analysis showed that over 9 months, there was a drop in median duration for all 4 phases of the workflow: Bed requested/assigned (113.50-75.00 minutes), bed assigned/ready (127.00-81.00 minutes), overall bed assigned/transport off the emergency department (63.00-59.00 minutes); however, data showed an increase in bed ready/nurse report (31.00-32.00 minutes), χ2(8) = 205.99, P < .001. These results subsequently contributed to an overall decrease in emergency department length of stay (8.90-7.70 hours). A hierarchical multiple regression model of month, duration of time of bed requested/assigned, bed assigned/ready, bed ready/nurse report, and overall bed assigned/ transport off the emergency department duration was also statistically significant, F (4, 6751) = 1073.57, P < .001, adjusted R² = 0.39. The full model showed that bed ready/nurse report accounted for 38.8% of the observed variation in results.

Discussion: A goal-driven timed target workflow standardization focusing on timing, direct communication, and escalation holds significant promise in increasing efficiency and ultimately improving emergency department inpatient admission.

Keywords: Collaboration; ED throughput; Goal-driven; Inpatient admission; Timed target; Workflow optimization.