RESUMO
BACKGROUND: Emergency departments (EDs) face problems with overcrowding, access block, cost containment, and increasing demand from patients. In order to resolve these problems, there is rising interest to an approach called "lean" management. This study aims to (1) evaluate the current patient flow in ED, (2) to identify and eliminate the non-valued added process, and (3) to modify the existing process. METHODS: It was a quantitative, pre- and post-lean design study with a series of lean management work implemented to improve the admission and blood result waiting time. These included structured re-design process, priority admission triage (PAT) program, enhanced communication with medical department, and use of new high sensitivity troponin-T (hsTnT) blood test. Triage waiting time, consultation waiting time, blood result time, admission waiting time, total processing time and ED length of stay were compared. RESULTS: Among all the processes carried out in ED, the most time consuming processes were to wait for an admission bed (38.24 minutes; SD 66.35) and blood testing result (mean 52.73 minutes, SD 24.03). The triage waiting time and end waiting time for consultation were significantly decreased. The admission waiting time of emergency medical ward (EMW) was significantly decreased from 54.76 minutes to 24.45 minutes after implementation of PAT program (P<0.05). CONCLUSION: The application of lean management can improve the patient flow in ED. Acquiescence to the principle of lean is crucial to enhance high quality emergency care and patient satisfaction.
RESUMO
BACKGROUND: The role of Inter-facility transport (IFT) of patients is an emerging specialty requiring service reorganization, diversion of major trauma to trauma center. This study aimed to determine the patients who are more prone to en route adverse event during the period of 22:00 to 07:00, based on critical in-patient needs provided by the Emergency Department (ED) nursing staff at Alice Ho Miu Ling Nethersole Hospital (AHNH). METHODS: This study included all 22:00 to 07:00 IFTs accompanied by ED nurses at AHNH for a period of 28 months from August 2006 until December 2008. The transports were reviewed for: (1) age, (2) gender, (3) transport configuration, (4) clinical category, and (5) physiological instability before transport. RESULTS: A total of 79 patients were transported during the 22:00 to 07:00 timeframe within the study period. The types of patients were mainly neurosurgical emergencies (n=32; 40.5%), surgical emergencies (n=28; 35.4%), and upper gastrointestinal bleeding (UGIB) (n=11; 13.9%). En route adverse events were encountered by the accompanying nurses in 16 transports (20.3%) with a higher incidence of adverse events during transport of surgical emergencies, UGIB and patients who were physiological unstable before transport (P< 0.05). CONCLUSION: A specialized transport team from the ED can assist other clinical departments by providing expert care during IFT. In spite of the high quality of care, adverse events do commonly occur.
