von Guionneau Alexandra, Burford Charlotte M
Life Sciences & Medicine, King's College London School of Medicine, London, UK.
BMJ Open Qual. 2019 Jul 10;8(3):e000542. doi: 10.1136/bmjoq-2018-000542. eCollection 2019.
Long waiting times in accident and emergency (A&E) departments remain one of the largest barriers to the timely assessment of critically unwell patients. In order to reduce the burden on A&Es, some trusts have introduced ambulatory care areas (ACAs) which provide acute assessment for general practitioner referrals. However, ACAs are often based on already busy acute medical wards and the availability of clinical space for clerking patients means that these patients often face long waiting times too. A cheap and sustainable method to reducing waiting times is to evaluate current space utilisation with the view to making use of underutilised workspace. The aim of this quality improvement project was to improve accessibility to pre-existing clinical spaces, and in doing so, reduce waiting times in acute admissions.
Data were collected retrospectively from electronic systems and used to establish a baseline wait time from arrival to having blood taken (primary outcome). Quality improvement methods were used to identify potential implementations to reduce waiting time, by increasing access to clinical space, with serial measurements of the primary outcome being used to monitor change.
Data were collected over 54 consecutive days. The median wait time increased by 55 min during the project period. However, this difference in waiting time was not deemed significant between the three PDSA cycles (p=0.419, p=0.270 and p=0.350, Mann-Whitney U). Run chart analysis confirmed no significant changes occurred.
In acute services, one limiting factor to seeing patients quickly is room availability. Quality improvement projects, such as this, should consider facilitating better use of available space and creating new clinical workspaces. This offers the possibility of reducing waiting times for both staff and patients alike. We recommend future projects focus efforts on integration of their interventions to generate significant improvements.
急诊部门的长时间等待仍然是对病情危急患者进行及时评估的最大障碍之一。为了减轻急诊部门的负担，一些信托机构设立了门诊护理区（ACA），为全科医生转诊患者提供急性评估。然而，门诊护理区通常设在本就繁忙的急性内科病房，用于接待患者的临床空间有限，这意味着这些患者往往也面临长时间等待。一种降低等待时间的低成本且可持续的方法是评估当前空间利用情况，以便利用未充分利用的工作空间。这个质量改进项目的目的是改善对现有临床空间的利用，从而减少急性入院患者的等待时间。
从电子系统中回顾性收集数据，并用于确定从到达至采血的基线等待时间（主要结果）。采用质量改进方法，通过增加临床空间的可及性来确定减少等待时间可能的实施措施，并用主要结果的系列测量值来监测变化。
连续54天收集数据。在项目期间，等待时间的中位数增加了55分钟。然而，在三个计划-实施-研究-改进（PDSA）循环之间，这种等待时间的差异被认为不显著（p = 0.419、p = 0.270和p = 0.350，曼-惠特尼U检验）。运行图分析证实未发生显著变化。
在急性医疗服务中，快速诊治患者的一个限制因素是病房可用性。像这样的质量改进项目应考虑促进对可用空间的更好利用，并创建新的临床工作空间。这为减少工作人员和患者的等待时间提供了可能性。我们建议未来的项目将工作重点放在整合干预措施上，以实现显著改进。
