How does clinical space utilisation impact patient flow?

Abstract

BackgroundLong waiting times in accident and emergency (A&E) departments remain one of the largest barriers to the timely assessment of critically unwell patients. In order to reduce the burden on A&Es, some trusts have introduced ambulatory care areas (ACAs) which provide acute assessment for general practitioner referrals. However, ACAs are often based on already busy acute medical wards and the availability of clinical space for clerking patients means that these patients often face long waiting times too. A cheap and sustainable method to reducing waiting times is to evaluate current space utilisation with the view to making use of underutilised workspace. The aim of this quality improvement project was to improve accessibility to pre-existing clinical spaces, and in doing so, reduce waiting times in acute admissions.MethodsData were collected retrospectively from electronic systems and used to establish a baseline wait time from arrival to having blood taken (primary outcome). Quality improvement methods were used to identify potential implementations to reduce waiting time, by increasing access to clinical space, with serial measurements of the primary outcome being used to monitor change.ResultsData were collected over 54 consecutive days. The median wait time increased by 55 min during the project period. However, this difference in waiting time was not deemed significant between the three PDSA cycles (p=0.419, p=0.270 and p=0.350, Mann-Whitney U). Run chart analysis confirmed no significant changes occurred.ConclusionIn acute services, one limiting factor to seeing patients quickly is room availability. Quality improvement projects, such as this, should consider facilitating better use of available space and creating new clinical workspaces. This offers the possibility of reducing waiting times for both staff and patients alike. We recommend future projects focus efforts on integration of their interventions to generate significant improvements.

The Impact of a Patient Participating in Evaluating Patient Safety by Using the Patient Measure of Safety in Saudi Arabia: A Cross-Sectional Study

“…Ten percent of respondents felt that there was inadequate staffing, which inhibited getting things done on time. Thus, these items are indicative of the need for improvement because they directly affect patient safety; similarly, it was evident in many studies the role of space in delivering safer care to patients 24,25 . Deficits in communication were identified with patient reports of conflicting information given to patients, and more than half of the staff did not always know about changes in care plans.…”

“…Thus, these items are indicative of the need for improvement because they directly affect patient safety; similarly, it was evident in many studies the role of space in delivering safer care to patients. 24 , 25 Deficits in communication were identified with patient reports of conflicting information given to patients, and more than half of the staff did not always know about changes in care plans. Lack of communication is a major factor in unsafe care and a risk factor for adverse events, and this issue was noted by the patient, which emphasized the importance of the patient role in detecting safety.…”

Looking to Improve Your Practice? Consider the Science of Quality Improvement to Get Started

“…Furthermore, because quality improvement involves everyone, 8 teams are essential for driving these initiatives. 11,18,24 A successful quality improvement project is characterized by the identification of a day-to-day leader who champions the cause, 25 inclusion of technical experts who understand different components of the system and processes, and securing of an executive sponsor who has the access and authority to obtain resources. 7,25 The importance of engaging teams to support a quality improvement effort cannot be understated.…”