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Reducing Length of Stay in the Emergency Department

10. juni 2017 opdateret af: Wan-Ching Lien, National Taiwan University Hospital Hsin-Chu Branch

Reducing Length of Stay in the Emergency Department: Analyzing the Factors and Quality Improvement Interventions

Emergency department (ED) crowding has become an international challenge in the recent decades.

Length of stay (LOS) is a useful marker to monitor ED crowding. Searching for the possible causes and reducing barriers may have the greatest impact on EDLOS.

Therefore, the investigators assembled a multidisciplinary team for improvement of the ED process, to undergo assessments of ED patient flow with the spirit of lean-sigma methodologies. The objectives of this study were to evaluate a Lean-sigma-based initiative to lessen EDLOS.

Studieoversigt

Status

Afsluttet

Betingelser

Intervention / Behandling

Detaljeret beskrivelse

Lean aims to smooth out the workflow and to eliminate wastes. In the ED settings, lean principles can display the process of the ED patient flow. Six sigma, a complementary strategy, has the merit to compensate the potential weakness of Lean through a data-driven process. Currently, a combination of Lean and Six sigma methodologies develops to solve the problems of workflow.

It became clear that concurrent multifaceted interventions were needed to reduce EDLOS. Therefore, the investigators assembled a multidisciplinary quality improvement team for improvement of the ED process, to undergo assessments of ED patient flow with the spirit of lean-sigma methodologies. The objectives of this study were to evaluate a Lean-sigma-based initiative to lessen EDLOS.

Undersøgelsestype

Observationel

Tilmelding (Faktiske)

72000

Deltagelseskriterier

Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.

Berettigelseskriterier

Aldre berettiget til at studere

  • Barn
  • Voksen
  • Ældre voksen

Tager imod sunde frivillige

Ingen

Køn, der er berettiget til at studere

Alle

Prøveudtagningsmetode

Ikke-sandsynlighedsprøve

Studiebefolkning

The patients were registered in the ED of the Hsin-Chu branch from Jan, 2015 to Dec, 2015.

Beskrivelse

Inclusion Criteria:

  • the patients were registered in the ED from Jan, 2015 to Dec, 2015.

Exclusion Criteria:

  • the patients were excluded because of left without seeing a physician.

Studieplan

Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.

Hvordan er undersøgelsen tilrettelagt?

Design detaljer

Kohorter og interventioner

Gruppe / kohorte
Intervention / Behandling
to reduce ED length of stay
to reduce ED length of stay to lessen ED crowding by using Lean-sigma management and quality improvement interventions including reducing boarding time and medical decision time.
Adfærdsmæssigt: Quality improvement (QI) interventions

1. The ED admissions exhibited prolonged length of stay.

2. The Interventions for Reducing Medical Decision Time:

  1. The ED director created QI education sessions and reported monthly QI outcomes.
  2. The ED nurses reported the current number of ED admission patients twice a day to the director. The director summarized the bed requests to the administrative personnel.
  3. The nurses reported the in-scene complicated cases to the ED director. The director would give an assistance in managing these cases.

3. The Interventions for Reducing Boarding Time

  1. The ED patients could be admitted before 8 a.m. if the bed was vacant.
  2. The ED director initiated an on-line meeting at 8 a.m. and 4 p.m.
  3. Monthly QI outcomes were reported in the hospital affairs meeting.

Hvad måler undersøgelsen?

Primære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
length of stay for ED admissions.
Tidsramme: 12 months
Length of stay was defined as the time from patient registration to leaving the ED.
12 months

Sekundære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
boarding time for ED admissions
Tidsramme: 12months
Boarding time was defined as the time from decision for admission to leaving the ED.
12months
decision time for ED admissions
Tidsramme: 12 months
Decision time was defined as the time from patient registration to decision for disposition.
12 months
the percentage of LOS over 24 hours in all ED patients.
Tidsramme: 12 months
The percentage was defined as patients staying at the ED over 24 hours/total ED visits.
12 months

Samarbejdspartnere og efterforskere

Det er her, du vil finde personer og organisationer, der er involveret i denne undersøgelse.

Sponsor

National Taiwan University Hospital Hsin-Chu Branch

Datoer for undersøgelser

Disse datoer sporer fremskridtene for indsendelser af undersøgelsesrekord og resumeresultater til ClinicalTrials.gov. Studieregistreringer og rapporterede resultater gennemgås af National Library of Medicine (NLM) for at sikre, at de opfylder specifikke kvalitetskontrolstandarder, før de offentliggøres på den offentlige hjemmeside.

Studer store datoer

Studiestart (Faktiske)

1. januar 2015

Primær færdiggørelse (Faktiske)

31. december 2015

Studieafslutning (Faktiske)

31. december 2015

Datoer for studieregistrering

Først indsendt

4. juni 2017

Først indsendt, der opfyldte QC-kriterier

10. juni 2017

Først opslået (Faktiske)

14. juni 2017

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Faktiske)

14. juni 2017

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

10. juni 2017

Sidst verificeret

1. juni 2017

Mere information

Begreber relateret til denne undersøgelse

Yderligere relevante MeSH-vilkår

Andre undersøgelses-id-numre

  • 105-061-E

Plan for individuelle deltagerdata (IPD)

Planlægger du at dele individuelle deltagerdata (IPD)?

JA

Lægemiddel- og udstyrsoplysninger, undersøgelsesdokumenter

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Ingen

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Kliniske forsøg med Opholdsvarighed

Kliniske forsøg med Quality improvement (QI) interventions

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Betingelser

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Kosttilskud

Sponsor / samarbejdspartnere

Placeringer

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