Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India.
Department of Paediatrics, All India Institute of Medical Sciences, New Delhi, India.
Emerg Med J. 2019 Sep;36(9):558-563. doi: 10.1136/emermed-2019-208577. Epub 2019 Jul 31.
Prolonged wait times prior to triage outside the emergency department (ED) were a major problem at our institution, compromising patient safety. Patients often waited for hours outside the ED in hot weather leading to exhaustion and clinical deterioration. The aim was to decrease the median waiting time to triage from 50 min outside ED for patients to <30 min over a 4-month period.
A quality improvement (QI) team was formed. Data on waiting time to triage were collected between 12 pm and 1 pm. Data were collected by hospital attendants and recorded manually. T1 was noted as a time of arrival outside the ED, and T2 was noted as the time of first medical contact. The QI team used plan-do-study-act cycles to test solutions. Change ideas to address these gaps were tested during May and June 2018. Change ideas were focused on improving the knowledge and skills of staff posted in triage and reducing turnover of triage staff. Data were analysed using run chart rules.
Within 6 weeks, the waiting time to triage reduced to <30 min (median, 12 min; IQR, 11 min) and this improvement was sustained for the next 8 weeks despite an increase in patient load.
The authors demonstrated that people new to QI could use improvement methods to address a specific problem. It was the commitment of the frontline staff, with the active support of senior leadership in the department that helped this effort succeed.
在急诊科外分诊前等待时间过长是我们机构的一个主要问题，危及患者安全。患者经常在炎热的天气下在急诊科外等待数小时，导致疲惫和临床恶化。目标是将在急诊科外等待分诊的中位数从 50 分钟减少到 4 个月内<30 分钟。
成立了一个质量改进（QI）团队。在中午 12 点至 1 点之间收集分诊等待时间的数据。数据由医院工作人员收集并手动记录。T1 记录为到达急诊科外的时间，T2 记录为首次医疗接触的时间。QI 团队使用计划-执行-研究-行动循环来测试解决方案。在 2018 年 5 月和 6 月期间，测试了针对这些差距的改进思路。改进思路侧重于提高分诊工作人员的知识和技能，并减少分诊工作人员的流动。使用运行图表规则分析数据。
在 6 周内，分诊等待时间减少到<30 分钟（中位数 12 分钟；IQR 11 分钟），尽管患者人数增加，但这种改善在接下来的 8 周内持续存在。
作者证明，新接触质量改进的人员可以使用改进方法来解决特定问题。这是一线工作人员的承诺，以及部门高层领导的积极支持，帮助这一努力取得了成功。
