Swancutt Dawn, Joel-Edgar Sian, Allen Michael, Thomas Daniel, Brant Heather, Benger Jonathan, Byng Richard, Pinkney Jonathan
Peninsula Schools of Medicine and Dentistry, University of Plymouth, ITTC Building, Plymouth Science Park, Plymouth, PL6 8BX, UK.
Department of Computer Science, University of Bath, Bath, UK.
BMC Health Serv Res. 2017 Jun 24;17(1):436. doi: 10.1186/s12913-017-2349-2.
Increasing pressure in the United Kingdom (UK) urgent care system has led to Emergency Departments (EDs) failing to meet the national requirement that 95% of patients are admitted, discharged or transferred within 4-h of arrival. Despite the target being the same for all acute hospitals, individual Trusts organise their services in different ways. The impact of this variation on patient journey time and waiting is unknown. Our study aimed to apply the Lean technique of Value Stream Mapping (VSM) to investigate care processes and delays in patient journeys at four contrasting hospitals.
VSM timing data were collected for patients accessing acute care at four hospitals in South West England. Data were categorised according to waits and activities, which were compared across sites to identify variations in practice from the patient viewpoint. We included Public and Patient Involvement (PPI) to fully interpret our findings; observations and initial findings were considered in a PPI workshop.
One hundred eight patients were recruited, comprising 25,432 min of patient time containing 4098 episodes of care or waiting. The median patient journey was 223 min (3 h, 43 min); just within the 4-h target. Although total patient journey times were similar between sites, the stage where the greatest proportion of waiting occurred varied. Reasons for waiting were dominated by waits for beds, investigations or results to be available. From our sample we observed that EDs without a discharge/clinical decision area exhibited a greater proportion of waiting time following an admission or discharge decision. PPI interpretation indicated that patients who experience waits at the beginning of their journey feel more anxious because they are 'not in the system yet'.
The novel application of VSM analysis across different hospitals, coupled with PPI interpretation, provides important insight into the impact of care provision on patient experience. Measures that could reduce patient waiting include automatic notification of test results, and the option of discharge/clinical decision areas for patients awaiting results or departure. To enhance patient experience, good communication with patients and relatives about reasons for waits is essential.
英国紧急护理系统面临的压力不断增加，导致急诊科未能达到在患者到达后4小时内让95%的患者入院、出院或转院的国家要求。尽管所有急症医院的目标相同，但各个信托机构组织服务的方式各不相同。这种差异对患者就医时间和等待时间的影响尚不清楚。我们的研究旨在应用价值流映射（VSM）这一精益技术，调查四家不同医院的护理流程及患者就医过程中的延误情况。
收集了英格兰西南部四家医院急性护理患者的VSM时间数据。数据根据等待时间和活动进行分类，并在各医院间进行比较，以从患者角度识别实际操作中的差异。我们纳入了公众和患者参与（PPI）以充分解读研究结果；在一次PPI研讨会上对观察结果和初步发现进行了审议。
招募了108名患者，患者总时长为25432分钟，包含4098次护理或等待事件。患者就医的中位时间为223分钟（3小时43分钟），刚好在4小时目标范围内。尽管各医院患者的总就医时间相似，但等待时间占比最大的阶段有所不同。等待的原因主要是等待床位、检查结果或检查可用。从我们的样本中观察到，没有出院/临床决策区域的急诊科在入院或出院决定后的等待时间占比更大。PPI解读表明，在就医旅程开始时经历等待的患者会感到更焦虑，因为他们“还未进入系统”。
VSM分析在不同医院的新颖应用，再加上PPI解读，为护理提供对患者体验的影响提供了重要见解。可以减少患者等待的措施包括自动通知检查结果，以及为等待结果或出院的患者设置出院/临床决策区域。为了提升患者体验，与患者及其亲属就等待原因进行良好沟通至关重要。
