Improving Emergency Department Patient Flow
Improving Emergency Department Patient Flow
http://dx.doi.org/10.15441/ceem.16.127
Review Article
Improving emergency department eISSN: 2383-4625
patient flow
Paul Richard Edwin Jarvis
Emergency Department, Calderdale & Huddersfield NHS Foundation Trust, West Yorkshire, UK
Emergency departments (ED) face significant challenges in delivering high quality and timely Received: 15 February 2016
patient care on an ever-present background of increasing patient numbers and limited hospital Revised: 2 March 2016
resources. A mismatch between patient demand and the ED’s capacity to deliver care often leads Accepted: 2 March 2016
to poor patient flow and departmental crowding. These are associated with reduction in the
Correspondence to:
quality of the care delivered and poor patient outcomes. A literature review was performed to
Paul Richard Edwin Jarvis
identify evidence-based strategies to reduce the amount of time patients spend in the ED in or-
Emergency Department, Calderdale
der to improve patient flow and reduce crowding in the ED. The use of doctor triage, rapid as- Royal Hospital, Dryclough Lane, Halifax,
sessment, streaming and the co-location of a primary care clinician in the ED have all been West Yorkshire HX3 0PW, UK
shown to improve patient flow. In addition, when used effectively point of care testing has been E-mail: paul.jarvis@cht.nhs.uk
shown to reduce patient time in the ED. Patient flow and departmental crowding can be im-
proved by implementing new patterns of working and introducing new technologies such as
point of care testing in the ED.
Keywords Emergency department; Patient flow; Improvement
64 www.ceemjournal.org
Paul Richard Edwin Jarvis
model reduces the overall journey time of patients in the ED. This pared with emergency physicians. However, there is some evidence
review article also demonstrated that the length of time it takes to suggest there is a potential for cost savings as general practi-
for patients to be seen by a doctor is reduced when a rapid as- tioners tend to order fewer tests and fewer admissions31,32 whilst
sessment model is utilised.27 patient satisfaction was increased.32 The waiting time for ED pa-
The costs of implementing such system is often cited as a bar- tients in hospitals with a colocated general practitioner service
rier to its introduction. However there is evidence that altering was on average 19% less than patients attending EDs without a
the existing work pattern within the ED and introducing a rapid primary care service.33
assessment model within the confines of existing departmental
resources is associated with improved patient flow.28 POINT-OF-CARE TESTING
However, Rooney and Schilling44 state that the time saved elimi- CONFLICT OF INTEREST
nating steps when POCT is introduced, such as the sample trans-
portation, registration of the sample in the laboratory and time No potential conflict of interest relevant to this article was re-
spent retrieving results, means the cost of utilising POCT seldom ported.
exceeds those of analysis in a centralised laboratory. An Austra-
lian study performed in 2014 concluded that each hour of patient REFERENCES
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