Memorial University of Newfoundland, Discipline of Family Medicine, St. John's, Newfoundland.
Eastern Health, Carbonear Institute for Rural Research and Innovation by the Sea, Carbonear General Hospital, Carbonear, Newfoundland.
West J Emerg Med. 2019 Jul;20(4):654-665. doi: 10.5811/westjem.2019.5.42027. Epub 2019 Jul 5.
Canadian emergency departments (ED) are struggling to provide timely emergency care. Very few studies have assessed attempts to improve ED patient flow in the rural context. We assessed the impact of SurgeCon, an ED patient-management protocol, on total patient visits, patients who left without being seen (LWBS), length of stay for departed patients (LOSDep), and physician initial assessment time (PIA) in a rural community hospital ED.
We implemented a set of commonly used methods for increasing ED efficiency with an innovative approach over 45 months. Our intervention involved seven parts comprised of an external review, Lean training, fast track implementation, patient-centeredness approach, door-to-doctor approach, performance reporting, and an action-based surge capacity protocol. We measured key performance indicators including total patient visits (count), PIA (minutes), LWBS (percentage), and LOSDep (minutes) before and after the SurgeCon intervention. We also performed an interrupted time series (ITS) analysis.
During the study period, 80,709 people visited the ED. PIA decreased from 104.3 (±9.9) minutes to 42.2 (±8.1) minutes, LOSDep decreased from 199.4 (±16.8) minutes to 134.4(±14.5) minutes, and LWBS decreased from 12.1% (±2.2) to 4.6% (±1.7) despite a 25.7% increase in patient volume between pre-intervention and post-intervention stages. The ITS analysis revealed a significant level change in PIA - 19.8 minutes (p<0.01), and LWBS - 3.8% (0.02), respectively. The change over time decreased by 2.7 minutes/month (p< 0.001), 3.0 minutes/month (p<0.001) and 0.4%/month (p<0.001) for PIA, LOSDep, and LWBS, after the intervention.
SurgeCon improved the key wait-time metrics in a rural ED in a country where average wait times continue to rise. The SurgeCon platform has the potential to improve ED efficiency in community hospitals with limited resources.
加拿大的急诊部门（ED）正在努力提供及时的紧急护理。很少有研究评估过在农村环境中改善 ED 患者流程的尝试。我们评估了 SurgeCon（一种 ED 患者管理方案）对农村社区医院 ED 的总就诊人数、未就诊离开的患者（LWBS）、已离院患者的停留时间（LOSDep）和医生初始评估时间（PIA）的影响。
我们在 45 个月的时间里实施了一系列常用的提高 ED 效率的方法，并采用了一种创新方法。我们的干预措施包括七个部分，包括外部审查、精益培训、快速实施、以患者为中心的方法、从门口到医生的方法、绩效报告和基于行动的应急能力协议。我们在 SurgeCon 干预前后测量了关键绩效指标，包括总就诊人数（计数）、PIA（分钟）、LWBS（百分比）和 LOSDep（分钟）。我们还进行了中断时间序列（ITS）分析。
在研究期间，有 80709 人到 ED 就诊。PIA 从 104.3（±9.9）分钟降至 42.2（±8.1）分钟，LOSDep 从 199.4（±16.8）分钟降至 134.4（±14.5）分钟，LWBS 从 12.1%（±2.2）降至 4.6%（±1.7），尽管在干预前后的患者数量增加了 25.7%。ITS 分析显示 PIA 发生了显著的水平变化，减少了 19.8 分钟（p<0.01），LWBS 减少了 3.8%（0.02）。干预后，PIA、LOSDep 和 LWBS 的时间变化分别减少了 2.7 分钟/月（p<0.001）、3.0 分钟/月（p<0.001）和 0.4%/月（p<0.001）。
SurgeCon 改善了农村 ED 的关键等待时间指标，而该国的平均等待时间仍在继续上升。SurgeCon 平台有可能提高资源有限的社区医院的 ED 效率。
