Department of Emergency Medicine, Haaglanden Medical Center, P.O. Box 432, 2501 CK The Hague, the Netherlands.
Department of Trauma Surgery, Haaglanden Medical Center, P.O. Box 432, 2501 CK The Hague, the Netherlands.
Int Emerg Nurs. 2024 Sep;76:101499. doi: 10.1016/j.ienj.2024.101499. Epub 2024 Aug 10.
Emergency department (ED) crowding is a widespread issue with adverse effects on patient care and outcomes.
ED crowding exacerbates wait times and compromises patient care, prompting opportunities for internal process improvement.
Over one week, the ED flow project team implemented four interventions, including an additional triage station, to optimize patient flow. We compared triage times, length of stay, crowding levels, and patient experiences with two control periods.
During peak hours, waiting times to triage decreased significantly with a median of 20 min (IQR 15-30) in the project week and 26 min (IQR 18-37) in the control weeks. Self-referrals decreased, while general practitioner referrals remained unchanged. Individual patient length of stay was unaffected, but crowding reduced notably during the project week. We found no difference in patient experiences between the periods.
The interventions contributed to reduced crowding and improved patient flow. The dedication of the ED flow project team and the ED nurses was crucial to these outcomes. An additional triage station during peak hours in the ED was established as a structural change.
急诊部门（ED）拥堵是一个普遍存在的问题，对患者的治疗和预后都有不良影响。
ED 拥堵加剧了等待时间，并影响了患者的治疗，因此需要进行内部流程改进。
在一周的时间里，ED 流程项目团队实施了四项干预措施，包括增加一个分诊站，以优化患者的流程。我们将两个控制期的分诊时间、住院时间、拥堵程度和患者体验进行了比较。
在高峰时段，分诊的等待时间显著缩短，项目周的中位数为 20 分钟（IQR 15-30），而对照周的中位数为 26 分钟（IQR 18-37）。自诊患者减少，而全科医生的转诊数量保持不变。患者的个体住院时间没有变化，但项目周的拥堵程度明显降低。我们没有发现两个时期患者体验有差异。
这些干预措施有助于减少拥堵，改善患者的流程。ED 流程项目团队和 ED 护士的奉献精神对这些结果至关重要。在 ED 的高峰时段增加一个分诊站是一个结构性的改变。
