Department of Medical Sciences, Uppsala University, Uppsala University Hospital, 751 85 Uppsala, Sweden.
Scand J Trauma Resusc Emerg Med. 2013 Nov 1;21:76. doi: 10.1186/1757-7241-21-76.
Long waiting times for emergency care are claimed to be caused by overcrowded emergency departments and non-effective working routines. Teamwork has been suggested as a promising solution to these issues. The aim of the present study was to investigate the effects of teamwork in a Swedish emergency department on lead times and patient flow.
The study was set in an emergency department of a university hospital where teamwork, a multi-professional team responsible for the whole care process for a group of patients, was introduced. The study has a longitudinal non-randomized intervention study design. Data were collected for five two-week periods during a period of 1.5 years. The first part of the data collection used an ABAB design whereby standard procedure (A) was altered weekly with teamwork (B). Then, three follow-ups were conducted. At last follow-up, teamwork was permanently implemented. The outcome measures were: number of patients handled within teamwork time, time to physician, total visit time and number of patients handled within the 4-hour target.
A total of 1,838 patient visits were studied. The effect on lead times was only evident at the last follow-up. Findings showed that the number of patients handled within teamwork time was almost equal between the different study periods. At the last follow-up, the median time to physician was significantly decreased by 11 minutes (p = 0.0005) compared to the control phase and the total visit time was significantly shorter at last follow-up compared to control phase (p = <0.0001; 39 minutes shorter on average). Finally, the 4-hour target was met in 71% in the last follow-up compared to 59% in the control phase (p = 0.0005).
Teamwork seems to contribute to the quality improvement of emergency care in terms of small but significant decreases in lead times. However, although efficient work processes such as teamwork are necessary to ensure safe patient care, it is likely not sufficient for bringing about larger decreases in lead times or for meeting the 4-hour target in the emergency department.
人们声称，急诊等待时间过长是由于急诊部门过于拥挤和工作流程效率低下造成的。团队合作被认为是解决这些问题的一个有前途的方案。本研究的目的是调查瑞典急诊部门团队合作对就诊时间和患者流程的影响。
该研究在一家大学医院的急诊部门进行，在该部门引入了团队合作，即一个多专业团队负责一组患者的整个护理过程。该研究采用纵向非随机干预研究设计。在 1.5 年的时间里，进行了为期五周的两次数据收集。数据收集的第一部分采用 ABAB 设计，每周标准程序（A）都用团队合作（B）进行改变。然后，进行了三次随访。最后一次随访时，团队合作永久实施。观察指标是：在团队合作时间内处理的患者人数、医生接诊时间、总就诊时间和在 4 小时目标内处理的患者人数。
共研究了 1838 例患者就诊。只有在最后一次随访时才观察到对就诊时间的影响。结果显示，在不同的研究期间，在团队合作时间内处理的患者人数几乎相等。在最后一次随访时，与对照组相比，医生接诊时间显著缩短了 11 分钟（p=0.0005），总就诊时间也显著缩短（p<0.0001；平均缩短 39 分钟）。最后，在最后一次随访时，4 小时目标的达标率为 71%，而对照组为 59%（p=0.0005）。
团队合作似乎有助于提高急诊护理质量，就诊时间有较小但显著的缩短。然而，尽管高效的工作流程，如团队合作，是确保患者安全护理所必需的，但对于进一步缩短就诊时间或达到急诊部门的 4 小时目标，可能还不够。
