Merahi Merahi Kefyalew, Argaw Rahel, Worku Aschalew, Molla Tsegaw, Abayneh Biruk, Mathewos Natnael, Amare Be'emnet, Kassahun Selamawit, Mekuria Kefelegn Negalign, Elssa Matyas Wondwossen
Addis Ababa University, College of Health Science, Addis Ababa, Ethiopia.
PLoS One. 2025 Sep 8;20(9):e0329316. doi: 10.1371/journal.pone.0329316. eCollection 2025.
Prolonged Emergency Department (ED) stays, a global issue driving overcrowding, were exacerbated at our hospital by lab delays and extended waits, increasing patient stress. This study aimed to reduce hematology patients' length of stay (LOS). Using the fishbone method to identify care barriers, three interventions were implemented: redesigned lab referral systems, an online specialist communication platform, and patient navigation floor maps.
At Tikur Anbessa Specialized Hospital (Ethiopia), a quality improvement initiative targeted hematology patients (n = 203 baseline; n = 63 post-intervention) with prolonged emergency department (ED) stays. Using two PDSA cycles, interventions included an online consultation platform, floor markings for navigation, and digitizing peripheral smear workflows via the I-Care system. Weekly data on consultation time, lab turnaround time (TAT), navigation errors, and length of stay (LOS) were analyzed with run charts and Interrupted Time Series (ITS) regression.
Median LOS decreased by 62.5% (144-54 hours; p < 0.001), remaining stable during a 5-week pause. Consultation time fell 80% (12 to 2.4 hours; 95% CI: 1.8-3.0), and lab TAT improved by 70% (78 to 23.25 hours). Navigation errors dropped from 53% to ≤7%, with minor fluctuations. Clinical outcomes (e.g., mortality) were not assessed, and long-term sustainability requires further study.
Targeted interventions improved care and efficiency at Tikur Anbessa Hospital, but sustained reductions in ED LOS were limited by data gaps and discontinued initiatives. Future efforts in resource-limited settings should prioritize continuous monitoring, stakeholder collaboration, and staff well-being.
急诊科停留时间延长是导致全球医院过度拥挤的一个问题，在我们医院，实验室检测延迟和等待时间延长加剧了这一问题，增加了患者的压力。本研究旨在缩短血液科患者的住院时间。我们使用鱼骨图方法识别护理障碍，并实施了三项干预措施：重新设计实验室转诊系统、一个在线专家沟通平台和患者导航楼层地图。
在提库尔·安贝萨专科医院（埃塞俄比亚），一项质量改进计划针对急诊科停留时间延长的血液科患者（基线时n = 203；干预后n = 63）。通过两个计划-执行-检查-行动（PDSA）循环，干预措施包括一个在线咨询平台、导航地面标识以及通过I-Care系统将外周血涂片工作流程数字化。使用运行图和中断时间序列（ITS）回归分析每周关于咨询时间、实验室周转时间（TAT）、导航错误和住院时间（LOS）的数据。
住院时间中位数下降了62.5%（从144小时降至54小时；p < 0.001），在为期5周的暂停期内保持稳定。咨询时间下降了
