Indus Hospital & Health Network, Karachi, Pakistan
Indus Hospital & Health Network, Karachi, Pakistan.
BMJ Open. 2023 Jul 20;13(7):e063413. doi: 10.1136/bmjopen-2022-063413.
A quasi-experimental study was conducted to estimate the impact of sequential emergency department (ED) capacity building interventions on key performance indicators such as patients' length of stay (LOS) and wait time (WT) during the COVID-19 pandemic. This was achieved through augmenting personnel education and head count, space restructuring and workflow reorganisation.
This study included 268 352 patients presenting from January 2019 to December 2020 at Indus Hospital and Health network Karachi, a philanthropic tertiary healthcare facility in a city of 20 million residents. A follow-up study was undertaken from January to December 2021 with 123 938 participants.
These included mean and median ED-LOS and WT for participants presenting in different cohorts. The results of the pre-COVID-19 year 2019 (phase 0) were compared with that of the COVID-19 year, 2020 (phases 1-3 corresponding to peaks, and phase 4 corresponding to reduction in caseloads). The follow-up was conducted in 2021 to see the sustainability of the sequential capacity building.
Phases 1, 2 and 3 had a lower mean adjusted LOS (4.42, 3.92 and 4.40 hours) compared with phase 0 (4.78 hours, p<0.05) with the lowest numbers seen in phase 2. The same held true for WT with 45.1, 23.8 and 30.4 min in phases 1-3 compared with 49.9 in phase 0. However, phase 4 had a higher LOS but a lower WT when compared with phase 0 with a p<0.05.
Sequential capacity building and improving the operational flow through stage appropriate interventions can be used to off-load ED patients and improve process flow metrics. This shows that models created during COVID-19 can be used to develop sustainable solutions and investment is needed in ideas such as ED-based telehealth to improve patient satisfaction and outcomes.
本准实验研究旨在评估在 COVID-19 大流行期间，通过增加人员教育和人员配备、空间重构和工作流程重组等方式对急诊部（ED）容量建设干预措施对患者停留时间（LOS）和等待时间（WT）等关键绩效指标的影响。
本研究包括 2020 年 1 月至 12 月在 Indus 医院和健康网络卡拉奇就诊的 268352 名患者，这是一个拥有 2000 万居民的城市中的慈善性三级医疗机构。2021 年 1 月至 12 月进行了后续研究，共纳入 123938 名参与者。
这些结果包括不同队列患者的 ED-LOS 和 WT 的平均值和中位数。将 2019 年（第 0 阶段）的 COVID-19 前年度结果与 2020 年的 COVID-19 年度结果（第 1-3 阶段对应高峰期，第 4 阶段对应病例数减少）进行比较。2021 年进行了随访，以观察连续容量建设的可持续性。
与第 0 阶段（4.78 小时，p<0.05）相比，第 1、2 和 3 阶段的平均调整 LOS（4.42、3.92 和 4.40 小时）较低，其中第 2 阶段的数值最低。WT 也同样如此，第 1-3 阶段分别为 45.1、23.8 和 30.4 分钟，而第 0 阶段为 49.9 分钟。然而，与第 0 阶段相比，第 4 阶段的 LOS 较高，但 WT 较低，p<0.05。
通过分阶段进行适当干预来进行连续容量建设和改善运营流程，可以用于减轻 ED 患者的负担并改善流程指标。这表明在 COVID-19 期间创建的模型可用于制定可持续的解决方案，需要投资 ED 基于远程医疗等想法，以提高患者满意度和结果。
