College of Social and Applied Human Sciences, University of Guelph, Guelph, ON.
CJEM. 2012 May;14(3):157-68. doi: 10.2310/8000.2012.110590.
A process improvement program (PIP) was implemented in the emergency department (ED) at Guelph General Hospital in July 2009. The purpose of this study was to examine patients' satisfaction and wait times by level of Canadian Triage and Acuity Scale (CTAS) score before and 6 months after implementation of this program.
Two samples were recruited: one was recruited before implementation of the PIP, January to June 2009 (T1), and one was recruited 6 months after implementation, January to June 2010 (T2). Patients were contacted by telephone to administer a survey including patient satisfaction with quality of care. Time to physician initial assessment, numbers left without being seen, and length of stay (LOS) were obtained from hospital records to compare wait times before and 6 months after implementation of the PIP.
Patients (n = 301) reported shorter wait times after implementation (e.g., 12% reported seeing a physician right away at T1 compared to 29% at T2). Time to physician initial assessment improved for patients with CTAS scores of III, IV, and V (average decrease from 2.1 to 1.7 hours), fewer patients (n = 425) left without being seen after implementation, and the mean and 90th percentile of LOS decreased for all patients except the mean LOS for discharged patients with a CTAS score of I. Total time spent in the ED for admitted patients decreased from 11.11 hours in the 2009 period to 9.95 in the 2010 period, and for nonadmitted patients, the total time decreased from 3.94 to 3.29 hours. The overall satisfaction score improved from a mean of 3.17 to 3.4 (of 4; p < 0.001).
Implementation of the ED PIP corresponded with decreased wait times, increased patient satisfaction, and improved patient flow for patients with CTAS scores of III, IV, and V.
2009 年 7 月，在圭尔夫综合医院的急诊部实施了一个流程改进计划（PIP）。本研究的目的是在实施该计划前后，根据加拿大分诊和急症量表（CTAS）评分水平，检查患者的满意度和等待时间。
招募了两个样本：一个是在 PIP 实施前，即 2009 年 1 月至 6 月（T1）招募的，另一个是在实施后 6 个月，即 2010 年 1 月至 6 月（T2）招募的。通过电话联系患者进行调查，包括对护理质量的满意度。从医院记录中获得就诊时间、未就诊人数和留观时间（LOS），以比较实施 PIP 前后的等待时间。
患者（n=301）报告说实施后等待时间缩短（例如，T1 时有 12%的患者立即就诊，而 T2 时有 29%）。CTAS 评分为 III、IV 和 V 的患者的就诊时间有所改善（平均从 2.1 小时减少到 1.7 小时），实施后未就诊的患者人数减少（n=425），除 CTAS 评分为 I 的出院患者的平均 LOS 外，所有患者的 LOS 平均值和 90 百分位均降低。除了 CTAS 评分为 I 的患者的留观时间外，住院患者的 ED 总时间从 2009 年的 11.11 小时减少到 2010 年的 9.95 小时，非住院患者的总时间从 3.94 小时减少到 3.29 小时。总体满意度评分从 3.17 提高到 3.4（满分 4 分；p<0.001）。
急诊部 PIP 的实施与等待时间缩短、患者满意度提高以及 CTAS 评分为 III、IV 和 V 的患者的患者流量改善有关。
