Reducing time to X-ray in emergency department ambulatory patients: a quality improvement project.

This quality improvement project began when physicians and nurses at our hospital observed patients waiting for excessive periods of time for a porter to escort patients from the emergency department (ED) to medical imaging (MI). However, certain patients may not need staff escort and are able to ambulate from ED to MI by themselves. This would reduce waiting time from when the X-ray is ordered to X-ray being done, which may reduce overall ED length of stay and improve patients' experience.Our project aim is to decrease the time to X-ray by 50% within 6 months by having appropriate ambulatory patients walk from the ED to the X-ray department without a porter. To achieve our goal, several strategies were employed. First, brainstorm sessions were held to better understand the barriers and ways to implement the new process. Second, a patient survey was conducted to understand their thoughts on the change idea. Third, data were collected to assess the inefficiency problem on the number of times non-porter staff escorted patients due to porters being unavailable. A total of 14 PDSA (Plan-Do-Study-Act) cycles were completed between December 2018 and May 2019. A human factor specialist was consulted to examine the process for safety and optimisation of the patient journey.In our PDSA cycles, self-ambulatory patients were compared with ambulatory patients who required an escort. An improvement was found from time to X-ray of 28 min (11 min vs 39 min). The new self-ambulatory process was implemented in June 2019 on a daily basis.

Access to Translator (AT&T) project: Interpreter on Wheels during the COVID-19 pandemic.

We report our experience in using virtual technology in our emergency department (ED) to meet communication needs of our patients who have limited English proficiency (LEP) during the COVID-19 pandemic. Our project aim was to improve communication between our ED staff and patients who have LEP. Specifically, our primary aim was to eliminate the use of healthcare staff as ad hoc interpreters by 50% in our ED by using virtual medical interpreters within 2 months. To achieve our goal, several strategies were employed. First, we assessed the need for interpreters in our ED by tracking the number of times our nursing staff is pulled away from their nursing role to help other staff as an ad hoc interpreter. Second, a patient survey was conducted to understand their thoughts and needs for interpretation in the ED. Third, we developed strategies in improving access to interpreters in our ED. During the COVID-19 pandemic, we conducted a trial of using 'Interpreter on Wheels' (IOW) in our ED. In a 2-month period, we had 477 virtual interpretation encounters totaling 4123 interpretation minutes of IOW usage. We found that it satisfied not only our communication needs but also reduced some of our potential infection control risks during the pandemic.