Department of Emergency Medicine, Penn State College of Medicine, Hershey, PA, USA
Department of Emergency Medicine, Penn State College of Medicine, Hershey, PA, USA.
HERD. 2015 Spring;8(3):105-15. doi: 10.1177/1937586715580949.
Healthcare system flow resulting in emergency departments (EDs) crowding is a quality and access problem. This case study examines an overcrowded academic health center ED with increasing patient volumes and limited physical space for expansion. ED capacity and efficiency improved via engineering principles application, addressing patient and staffing flows, and reinventing the delivery model. Using operational data and staff input, patient and staff flow models were created, identifying bottlenecks (points of inefficiency). A new flow model of emergency care delivery, physician-directed queuing, was developed. Expanding upon physicians in triage, providers passively evaluate all patients upon arrival, actively manage patients requiring fewer resources, and direct patients requiring complex resources to further evaluation in ED areas. Sustained over time, ED efficiency improved as measured by near elimination of "left without being seen" patients and waiting times with improvement in door to doctor, patient satisfaction, and total length of stay. All improvements were in the setting on increased patient volume and no increase in physician staffing. Our experience suggests that practical application of healthcare delivery science can be used to improve ED efficiency.
医疗保健系统流程导致急诊部门（EDs）拥堵是一个质量和可及性问题。本案例研究考察了一个拥挤的学术医疗中心 ED，患者数量不断增加，而扩展的物理空间有限。通过应用工程原理、解决患者和人员流程以及重新设计交付模式，提高了 ED 的容量和效率。利用运营数据和员工的投入，创建了患者和员工的流量模型，确定了瓶颈（效率低下的点）。开发了一种新的急诊护理交付流程模型，即医生指导的排队。除了分诊医生，还让医护人员在患者到达时主动管理需要较少资源的患者，并将需要更多资源的患者引导至 ED 区域进行进一步评估。随着时间的推移，ED 的效率得到了提高，表现为“未得到诊治就离开”的患者数量几乎消除，以及等待时间从医生到达到病人、病人满意度和总住院时间都有所改善。所有这些改进都是在患者数量增加且医生人手没有增加的情况下实现的。我们的经验表明，医疗保健交付科学的实际应用可以用来提高 ED 的效率。
