Al Halabi Anas M, Habas Elmukhtar, Ghazouani Hafedh, Borham Abdelsalam M, Swallmeh Esmat, Abou-Samra Abdul-Badi
Quality and Patient Safety, Hamad Medical Corporation, Doha, QAT.
Internal Medicine, Hamad General Hospital, Doha, QAT.
Cureus. 2022 Oct 27;14(10):e30751. doi: 10.7759/cureus.30751. eCollection 2022 Oct.
Background Shortening the patient experience time (PET) in the emergency department (ED) improves patient quality and satisfaction and reduces mortality and morbidity. Worldwide, the PET target in the ED is ≤ 6 hours; however, the PET awaiting admission to inpatient Medicine at Hamad General Hospital (HGH) in the Qatar State, through ED is currently 15.3±6.4 (mean ± SD) hours. Aim Identify solutions to reduce the PET duration at HGH-ED to the international target. Method A cohort study was done using the Discrete-event simulation (DES) model, utilizing a commercial simulation software package (Process Model Inc., Utah, version 5.2.0). One-year data, January 1, 2019 - December 30, 2019, was analyzed and found to follow seven subprocesses. The duration of each subprocess was recorded, and the average time was calculated. A computer simulation scheme was developed for all the subprocesses of the actual PET duration. The simulated PET was validated, and scenarios were proposed and assessed for each subprocess separately and in combination, A constructed simulatory design using an iterative process involving a construction model. This model starts with the logical organization of submitted tasks based on their cycle times. A subject-matter expert interview was conducted to determine the appropriateness and frequency of actions. The duration of each activity in the considered process was defined using a triangular distribution. Results The actual PET duration for the Medical Department was 15.3±6.4 (mean + SD) hours. The three most prolonged PET subprocess durations were in the referral to internal medicine, the decision to admit, and finding a free bed; these represent 17.9%, 53.8%, and 16.7% of the PET, respectively. Adding two physicians to each shift, which shortens the subprocess of the decision to admit, reduced the PET duration by 27.5%. Moreover, creating a new admitting team (unit) that takes care of new patients admitted to the ED reduced PET duration by another 12.5%. Combining these two scenarios reduced the average PET duration to only 10.2±0.5 hours. In addition to these scenarios, the PET can be further decreased to six hours by increasing the number of inpatient beds. Conclusions The simulated scenarios indicated that restructuring the medical teams, adding two physicians to each shift, and creating an admissions team dedicated to the ED would reduce the total PET duration to 10.2 hours, Furthermore, PET's further reduction to six hours is predictable by increasing the bed number.
缩短急诊科患者就诊时间（PET）可提高患者质量和满意度，并降低死亡率和发病率。在全球范围内，急诊科的PET目标是≤6小时；然而，卡塔尔国哈马德总医院（HGH）通过急诊科等待入住内科病房的PET目前为15.3±6.4（均值±标准差）小时。目的：确定将HGH急诊科的PET时长缩短至国际目标的解决方案。方法：使用离散事件模拟（DES）模型进行队列研究，采用商业模拟软件包（Process Model Inc.，犹他州，版本5.2.0）。分析了2019年1月1日至2019年12月30日这一年的数据，发现其遵循七个子流程。记录每个子流程的时长，并计算平均时间。针对实际PET时长的所有子流程制定了计算机模拟方案。对模拟的PET进行了验证，并分别和综合地针对每个子流程提出并评估了各种情景，使用涉及构建模型的迭代过程构建了模拟设计。该模型从根据提交任务的周期时间进行逻辑组织开始。进行了主题专家访谈以确定行动的适当性和频率。使用三角分布定义了所考虑流程中每个活动的时长。结果：内科的实际PET时长为15.3±6.4（均值+标准差）小时。PET最长的三个子流程时长分别是转诊至内科、决定收治和找到空床；这些分别占PET的17.9%、53.8%和16.7%。每班增加两名医生，这缩短了决定收治的子流程，使PET时长减少了27.5%。此外，创建一个负责急诊科新收治患者的新收治团队（单元）使PET时长又减少了12.5%。将这两种情景结合起来可将平均PET时长降至仅10.2±0.5小时。除了这些情景外，增加住院床位数量可使PET进一步降至6小时。结论：模拟情景表明，重组医疗团队、每班增加两名医生以及创建一个专门负责急诊科的收治团队可将总PET时长降至10.2小时。此外，通过增加床位数可预测PET进一步降至6小时。
