Hospital-based continuous quality improvement: a realistic appraisal.

OBJECTIVE

To evaluate the impact of a continuous quality improvement (CQI) multidisciplinary team process on emergency department admission times.

DESIGN

Prospective observational intervention study.

SETTING

A 349-bed tertiary care, university-affiliated, pediatric teaching hospital.

RESULTS

The time from triage to departure from the emergency department (T1-T3) was reduced by 71 minutes, and the time from the decision to admit to departure from the emergency department (T2-T3) by 38 minutes following the planned interventions. There was no correlation between admission times and hospital inpatient census, number of emergency department admissions on a given day, or work shift. Medical patients were transferred to the wards more slowly than patients admitted by the general surgery service and several specialty surgical services once the decision to admit had been reached. No major adverse clinical outcomes could be attributed to expedited admissions. Physicians and nurses in the emergency department expressed improved satisfaction with the admissions process, while houseofficers on the wards were less satisfied. Parental satisfaction with the speed of admissions remained suboptimal. Additional potential problems with the application of CQI principles in an academic setting were identified.

CONCLUSIONS

Although CQI is a promising approach to certain quality problems, a number of issues remain to be explored before full-scale implementation in academic centers can be endorsed.