Khanna Sankalp, Boyle Justin, Good Norm, Bell Anthony, Lind James
CSIRO Australian e-Health Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
Department of Emergency Medicine, Critical Care and Clinical Support Services, Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
Emerg Med Australas. 2017 Feb;29(1):18-23. doi: 10.1111/1742-6723.12693. Epub 2016 Nov 8.
Despite significant workflow reform to comply with the federally mandated National Emergency Access Target (NEAT), Australian public hospitals continue to face significant barriers in achieving good ED patient flow. This study was undertaken to identify and analyse the impact of individual waypoints on an ED patient's journey and identify which waypoints act as bottlenecks to a hospital's 4 h ED disposition performance.
This study involves retrospective analysis and simulation employing 2 years of ED administrative data from a sample of two major and two large metropolitan hospitals in Queensland, Australia. The main outcome measures included waypoint wait times (Treatment Delay and Departure Delay), ED length of stay (EDLOS) and compliance with the NEAT target, measured for all (overall NEAT) and admitted (Admitted NEAT) patients. Variations in outcome measures were analysed as functions of hour of day, day of week, departure status and triage category. Simulations identified the impact of potential ED workflow changes in the context of NEAT performance.
Departure Delay accounted for 60 and 20% of EDLOS across large and major metropolitan hospitals, respectively. Higher gains in NEAT compliance are associated with improvements in departure delay rather than treatment delay. Simulation identified that halving Departure Delay improves Admitted NEAT by up to 22 and 4% at large and major metropolitan hospitals, respectively.
The results reinforces the need for a whole-of-hospital effort to address flow bottlenecks, and identify moving a patient from emergency to inpatient care as the critical bottleneck in ED system performance.
尽管澳大利亚公立医院为遵守联邦政府规定的国家紧急就诊目标（NEAT）进行了重大的工作流程改革，但在实现良好的急诊科患者流程方面仍面临重大障碍。本研究旨在识别和分析各个关键点对急诊科患者就医过程的影响，并确定哪些关键点是医院4小时急诊科处置绩效的瓶颈。
本研究采用回顾性分析和模拟方法，利用澳大利亚昆士兰州两家大型和两家大都会医院样本的两年急诊科管理数据。主要结局指标包括关键点等待时间（治疗延迟和出院延迟）、急诊科住院时间（EDLOS）以及符合NEAT目标的情况，对所有（总体NEAT）和入院（入院NEAT）患者进行测量。分析结局指标的变化作为一天中的时间、一周中的日期、出院状态和分诊类别的函数。模拟确定了在NEAT绩效背景下潜在的急诊科工作流程变化的影响。
在大型和主要大都会医院，出院延迟分别占EDLOS的60%和20%。NEAT合规性的更高提升与出院延迟的改善相关，而非治疗延迟。模拟表明，将出院延迟减半分别可使大型和主要大都会医院的入院NEAT提高22%和4%。
结果强调了全院共同努力解决流程瓶颈的必要性，并确定将患者从急诊科转移到住院治疗是急诊科系统绩效的关键瓶颈。
