Yuzeng Shen, Hui Lee Lin
Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
Organization Planning & Performance, Singapore General Hospital, Singapore, Singapore.
BMJ Open Qual. 2020 Feb;9(1). doi: 10.1136/bmjoq-2019-000708.
Triaging of patients at the emergency department (ED) is one of the key steps prior to initiation of doctor consult. To improve the overall wait time to consultation, we have identified the need to reduce the wait time to triage for ED patients. We seek to determine if the implementation of a series of plan, do, study, act (PDSA) cycles would improve the wait time to triage within 1 year. The interventions related to the PDSA cycles include the refining of triage criteria, 'eyeball' triage by senior nurses to facilitate direct bedding of patients, formation of a triage nurse clinician role, and a needs analysis of required nursing manpower. The baseline period for this study was from January 2017 to April 2017, with the results following implementation of the respective PDSA cycles sequentially tracked from May 2017 to March 2019. There was an improvement in the wait time to triage from a baseline duration of 18 min to the postimplementation period duration of 13 min, with a 25% decrease in variance from 16 to 12 min. The improvements were sustained. Strategies to further reduce wait time to triage at the ED are discussed. We also highlight the importance of adequate triage manpower, data-driven decision making and continued engagement of stakeholders in enabling positive outcomes from this quality improvement effort.
在急诊科对患者进行分诊是开始医生会诊之前的关键步骤之一。为了缩短会诊的总体等待时间，我们确定有必要减少急诊科患者的分诊等待时间。我们试图确定实施一系列计划-实施-研究-改进（PDSA）循环是否能在1年内缩短分诊等待时间。与PDSA循环相关的干预措施包括完善分诊标准、由资深护士进行“快速”分诊以促进患者直接入院、设立分诊护士临床医生岗位以及对所需护理人力进行需求分析。本研究的基线期为2017年1月至2017年4月，从2017年5月至2019年3月依次跟踪各PDSA循环实施后的结果。分诊等待时间从基线时长18分钟改善至实施后的13分钟，方差从16分钟降至12分钟，降幅为25%。这些改善得以持续。本文讨论了进一步缩短急诊科分诊等待时间的策略。我们还强调了充足的分诊人力、数据驱动的决策以及利益相关者持续参与对于通过这项质量改进工作取得积极成果的重要性。
