Emergency Department, Launceston General Hospital, Tasmanian Health Service, P.O. Box 1963, Launceston, Tasmania 7250, Australia; School of Nursing, University of Tasmania, Locked Bag 1322, University of Tasmania, Launceston, Tasmania 7250, Australia.
Emergency Department, Launceston General Hospital, Tasmanian Health Service, P.O. Box 1963, Launceston, Tasmania 7250, Australia; School of Nursing, University of Tasmania, Locked Bag 1322, University of Tasmania, Launceston, Tasmania 7250, Australia.
Int Emerg Nurs. 2021 Jan;54:100956. doi: 10.1016/j.ienj.2020.100956. Epub 2020 Dec 24.
Increasing emergency department (ED) demand and crowding has heightened focus on the need for better understanding of patient flow.
This study aimed to identify input, throughput and output factors contributing to ED patient flow bottlenecks and extended ED length of stay (EDLOS).
Concurrent nested mixed method study based on retrospective analysis of attendance data, patient flow observational data and a focus group in an Australian regional ED.
Analysis of 89 013 ED presentations identified increased EDLOS, particularly for patients requiring admission. Mapping of 382 patient journeys identified delays in time to triage assessment (0-39 mins) and extended waiting room stays (0-348 mins). High proportions of patients received care outside ED cubicles. Four qualitative themes emerged: coping under pressure, compromising care and safety, makeshift spaces, and makeshift roles.
Three key findings emerged: i) hidden waits such as extended triage-queuing occur during the input phase; ii) makeshift spaces are frequently used to assess and treat patients during times of crowding; and iii) access block has an adverse effect on output flow. Data suggests arrival numbers may not be a key predictor of EDLOS. This research contributes to our understanding of ED crowding and patient flow, informing service delivery and planning.
不断增加的急诊部门（ED）需求和拥挤情况使得人们更加关注需要更好地了解患者流量。
本研究旨在确定导致 ED 患者流量瓶颈和延长 ED 停留时间（EDLOS）的输入、吞吐量和输出因素。
基于澳大利亚地区 ED 的就诊数据、患者流量观察数据和焦点小组的回顾性分析，进行同期嵌套混合方法研究。
对 89013 例 ED 就诊的分析表明，EDLOS 延长，特别是需要入院的患者。对 382 名患者就诊路径的映射显示，分诊评估（0-39 分钟）和等候室停留时间（0-348 分钟）延长。大量患者在 ED 小隔间外接受治疗。出现了四个定性主题：在压力下应对、权衡护理和安全、临时空间和临时角色。
有三个关键发现：i）输入阶段会出现隐藏的等待，如延长的分诊排队；ii）在拥挤时，经常使用临时空间来评估和治疗患者；iii）接诊阻塞对输出流量有不利影响。数据表明，到达人数可能不是 EDLOS 的关键预测因素。这项研究有助于我们了解 ED 拥挤和患者流量情况，为服务提供和规划提供信息。
