Emptying the Corridors of Shame: Organizational Lessons From England's 4-Hour Emergency Throughput Target

Weber, Ellen J; Mason, Suzanne; Carter, Angela; Hew, Ruth

doi:10.1016/j.annemergmed.2010.08.013

Cited by 84 publications

(103 citation statements)

References 34 publications

Supporting

Mentioning

102

Contrasting

Order By: Relevance

“…Earlier studies have, however, noted similar findings, particularly with regards the value of expanded nurse roles in increasing productivity and concerns about lack of compassionate care when targets are pursued 25. Future work should aim to expose the model of productivity to test in other EDs in order to establish its validity.…”

Section: Discussionmentioning

confidence: 64%

ED healthcare professionals and their notions of productivity

Moffatt

Timmons²,

Coffey

2016

Emerg Med J

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 64%

ED healthcare professionals and their notions of productivity

Moffatt

Timmons²,

Coffey

2016

Emerg Med J

View full text Add to dashboard Cite

show abstract

“…The intense focus on hand hygiene guidelines and the re-packaged WHO guidelines must not divert us from all the many aspects of infection control. Cleanliness of wards and the quality of hospital cleaning services may have deteriorated, 56 basic nursing care has been gradually passed on to less experienced members of the care team, 57 higher patient-to-nurse ratios on the wards have at times resulted in sub-optimal patient care, 58 bed and side-room shortages have led to inappropriate mixing of infected, non-infected and vulnerable patients 59 and frequent transfers of patients from one unit to another in order to meet government-dictated treatment time targets, which have become more frequent in the United Kingdom, [60][61][62] can contribute to increasing environmental contamination. Prevention therefore requires a multimodal approach and co-operation between all hospital staff including management, physicians and surgeons, nursing staff, house-keeping and other affiliated services.…”

Section: After Contact With Inanimate Surfaces and Objects (Includingmentioning

confidence: 99%

The World Health Organization ‘5 Moments of Hand Hygiene’

Chou

Achan

Ramachandran

2012

The Journal of Bone and Joint Surgery. British volume

View full text Add to dashboard Cite

The World Health Organization (WHO) launched the first Global Patient Safety Challenge in 2005 and introduced the ‘5 moments of hand hygiene’ in 2009 in an attempt to reduce the burden of health care associated infections. Many NHS trusts in England adopted this model of hand hygiene, which prompts health care workers to clean their hands at five distinct stages of caring for the patient. Our review analyses the scientific foundation for the five moments of hand hygiene and explores the evidence, as referenced by WHO, to support these recommendations. We found no strong scientific support for this regime of hand hygiene as a means of reducing health care associated infections. Consensus-based guidelines based on weak scientific foundations should be assessed carefully to prevent shifting the clinical focus from more important issues and to direct limited resources more effectively. We recommend caution in the universal adoption of the WHO ‘5 moments of hand hygiene’ by orthopaedic surgeons and other health care workers and emphasise the need for evidence-based principles when adopting hospital guidelines aimed at promoting excellence in clinical practice.

show abstract

“…41 Similar to our findings, involvement and active support by top management was critical to reduce ED congestion and improve hospital patient flow. 35,41,48 One successful method for reducing admit wait times is to take admitted ED patients who would otherwise be boarded in ED hallways and move them directly to the hallways of their designated inpatient floors while they await open beds. 49 This practice has been implemented in some areas of the United States and was shown to be safe.…”

Section: Discussionmentioning

confidence: 99%

“…The study highlighted the need to 1) emphasize the responsibility of the entire organization, not just the ED; 2) focus on improving patient care, avoiding premature movement of patients at risk; and 3) identify all stakeholders to achieve the target for optimal throughput. 48 Organizational efficiency and effectiveness improvement resulted from the collaboration and shared ownership of the process. Similarly, the University Health System ED in San Antonio, Texas, worked with its inpatient unit and housekeeping staff to reduce bed turnaround time from 160 minutes to less than 30 minutes, resulting in an 8.5% decrease in overall length of ED throughput time.…”

Section: Discussionmentioning

confidence: 99%

Reduction of Admit Wait Times: The Effect of a Leadership‐based Program

Patel

Combs

Vinson

2014

Academic Emergency Medicine

View full text Add to dashboard Cite

Objectives: Prolonged admit wait times in the emergency department (ED) for patients who require hospitalization lead to increased boarding time in the ED, a significant cause of ED congestion. This is associated with decreased quality of care, higher morbidity and mortality, decreased patient satisfaction, increased costs for care, ambulance diversion, higher numbers of patients who leave without being seen (LWBS), and delayed care with longer lengths of stay (LOS) for other ED patients. The objective was to assess the effect of a leadership-based program to expedite hospital admissions from the ED.Methods: This before-and-after observational study was undertaken from 2006 through 2011 at one community hospital ED. A team of ED and hospital leaders implemented a program to reduce admit wait times, using a computerized hospital-wide tracking system to monitor inpatient and ED bed status. The team collaboratively and consistently moved ED patients to their inpatient beds within an established goal of 60 minutes after an admission decision was reached. Top leadership actively intervened in real time by contacting staff whenever delays occurred to expedite immediate solutions to achieve the 60-minute goal. The primary outcome measures were the percentage of ED patients who were admitted to inpatient beds within 60 minutes from the time the beds were requested and ED boarding time. LOS, patient satisfaction, LWBS rate, and ambulance diversion hours were also measured.Results: After ED census, hospital admission rates, and ED bed capacity were controlled for using a multivariable linear regression analysis, the admit wait time reduction program contributed to an increase in patients being admitted to the hospital within 60 minutes by 16 percentage points (95% confidence intervals [CI] = 10 to 22 points; p < 0.0001) and a decrease in boarding time per admission of 46 minutes (95% CI = 63 to 82 minutes; p < 0.0001). LOS decreased for admitted patients by 79 minutes (95% CI = 55 to 104 minutes; p < 0.0001), for discharged patients by 17 minutes (95% CI = 12 to 23 minutes; p < 0.0001), and for all patients by 34 minutes (95% CI = 25 to 43 minutes; p < 0.0001). Patient satisfaction increased 4.9 percentage points (95% CI = 3.8 to 6.0 points; p < 0.0001). LWBS patients decreased 0.9 percentage points (95% CI = 0.6 to 1.2 points; p < 0.0001) and monthly ambulance diversion decreased 8.2 hours (95% CI = 4.6 to 11.8 hours; p < 0.0001).Conclusions: A leadership-based program to reduce admit wait times and boarding times was associated with a significant increase in the percentage of patients admitted to the hospital within 60 minutes and a significant decrease in boarding time. Also associated with the program were decreased ED LOS, LWBS rate, and ambulance diversion, as well as increased patient satisfaction.ACADEMIC EMERGENCY MEDICINE 2014; 21:266-273

show abstract

Emptying the Corridors of Shame: Organizational Lessons From England's 4-Hour Emergency Throughput Target

Cited by 84 publications

References 34 publications

ED healthcare professionals and their notions of productivity

ED healthcare professionals and their notions of productivity

The World Health Organization ‘5 Moments of Hand Hygiene’

Reduction of Admit Wait Times: The Effect of a Leadership‐based Program

Contact Info

Product

Resources

About