Identification of Root Causes for Emergency Diagnostic Imaging Delays at Three Canadian Hospitals

Worster, Andrew; Fernandes, Christopher M.B.; Malcolmson, Cheryl; Eva, Kevin W.; Simpson, Diane

doi:10.1016/j.jen.2006.04.002

Cited by 18 publications

(15 citation statements)

References 4 publications

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“…Whereas, those that did not adhere to clinical guidelines [14], 0% changed ongoing patient management and/or assisted in clinical decision making. Specifically, there appeared to be a correlation between guideline adherence, and the medical test altering the patients' ongoing management.…”

Section: Resultsmentioning

confidence: 99%

“…This increase has resulted in an increased demand and bed shortages, with occupancy rates in many hospitals greater than 85%, which has been considered the maximum level for efficiency [13]. Access block has been linked to increased ED waiting times for medical care, which has led to overcrowding [14], [15]. It is unknown whether limiting imaging services to after-hours (on-call) specifically contributes to access block within EDs, although it has been documented that EDs are facing issues associated with the impact of access block associated with radiology and pathology referrals [13].…”

Section: Introductionmentioning

confidence: 99%

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Are all after-hours diagnostic imaging appropriate? An Australian Emergency Department pilot study

Gardiner

Zhai

2016

Annals of Medicine &Amp; Surgery

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BackgroundThis study was aimed at determining the extent to which after-hours diagnostic imaging is appropriate within the case hospital's Emergency Department. This was amid growing concerns of the inappropriateness of some medical investigations within the Australian health-care system.MethodsAfter-hours referral data and patient notes were used in reviewing the clinical case. Diagnostic imaging was deemed appropriate if reflective of clinical guidelines, and if not reflective, whether the investigation changed the patient's ongoing management.ResultsResults indicated that 96.37% of after-hours diagnostic imaging adhered to clinical guidelines and was appropriately requested, with 95.85% changing the ongoing management of the patient. The most sought after diagnostic imaging procedures were Chest X-Ray (30.83%), and CT Brain (16.58%), with 99.16% and 98.44 appropriateness respectively. Chest pain (14.49%) and motor vehicle accidents (8.12%) were the leading reason for ordering after-hours imaging.ConclusionThis study provided an Emergency Department example as it relates to after-hours diagnostic imaging appropriateness. This study found that most after-hours referrals were appropriate.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Are all after-hours diagnostic imaging appropriate? An Australian Emergency Department pilot study

Gardiner

Zhai

2016

Annals of Medicine &Amp; Surgery

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“…We measured the time spent on each of the daily tasks observed at clinics and CHCs, and used the data collected to measure standard times required to perform all aspects of screening. Previous studies have validated time-and-motion methodologies within clinical settings to improve procedures, and increase productivity [21,22]. …”

Section: Methodsmentioning

confidence: 99%

Comparison of patient flow and provider efficiency of two delivery strategies for HPV-based cervical cancer screening in Western Kenya: a time and motion study

Olwanda

Shen

Kahn

et al. 2018

Global Health Action

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Background: Improving patient flow and reducing over-crowding can improve quality, promptness of care, and patient satisfaction. Given low utilization of preventive care in low-resource countries, improved patient flows are especially important in these settings. Objective: Compare patient flow and provider efficiency between two cervical cancer screening strategies via self-collected human papillomavirus (HPV). Methods: We collected time and motion data for patients screened for cervical cancer in 12 communities in rural Migori County, Kenya as part of a larger cluster randomized trial. Six communities were randomized to screening in community health campaigns (CHCs) and six to screening at government clinics. We quantified patient flow: duration spent on each active stage of screening and wait times, and the number of patients arriving at CHCs and clinics each hour of the day. In addition, for four CHCs, we collected time and motion data for providers, and measured provider efficiency as a ratio of active (service delivery) time to total time spent at the clinic. Results: Total duration of screening visits, at CHCs and clinics was 42 and 87 minutes, respectively (p < 0.001 for difference). Total active time lasted longer at CHCs, with a mean of 28 minutes per patient versus 15 minutes at clinics, largely due to differences in duration for group education (p < 0.001). Wait time for registration at clinics was 36 minutes, explaining most of the difference between settings, but sometimes incorporated other health services. Conclusions: There is a substantial difference in patient flow at clinics compared to CHCs. Shorter duration at CHCs suggests that the model is favorable for patients in limiting time spent on screening. Future cervical cancer screening programs designed for scale-up should consider how this advantage may enhance satisfaction and uptake. For clinic-based screening programs, efforts could be made towards reducing registration wait times.

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“…Time and motion study was conducted by Worster et al identified 3 root causes of delay (a processing of radiograph request order by registered nurse, transport times, and radiology suite location [5].…”

Section: Introductionmentioning

confidence: 99%

Role of Time Study in Emergency Department of an Indian Hospital for Quality Health Care

Khekale¹,

Askhedkar²,

Parikh³

et al. 2016

Asian J Pharm Clin Res

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Objectives: To study the role of time study in the emergency department (ED) of an Indian hospital for quality health care. For that, an observational cross-sectional time study was conducted at the casualty department of largest hospitals situated at central India.Methods: Systemic random sampling method is used to select the patients attending the ED. Following parameters and procedure were observed during time study in the casualty department. Patient shifting on bed in ED, patient attending by nursing staff, patient attending and treatment by casualty medical officer (CMO), waiting time for intensivist, diagnostic procedure, waiting time for bed and after the availability of bed, patient was shifted to Intensive Coronary Care Unit (ICCU)/Intensive Care Unit (ICU)/ward. Results:Waiting times are observed which are of five types such as waiting for ward boy, CMO, intensivist, diagnostic procedure, and for bed in ICCU or ICU or ward. Conclusion:Result of this time and motion study shows that after the entry of the patient in the ED, he or she is subjected to different kinds of waits like for ward boy, intensivist, diagnostic tests, bed in ICCU or ICU or ward. Out of this, wait for intensivist and for bed are very important for the overall treatment of the patient. The hospital should aim at reducing these waits by proper management. This study focuses scope for the improvements in patient waiting time which is the important contributor of the patient satisfaction.

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Identification of Root Causes for Emergency Diagnostic Imaging Delays at Three Canadian Hospitals

Cited by 18 publications

References 4 publications

Are all after-hours diagnostic imaging appropriate? An Australian Emergency Department pilot study

Are all after-hours diagnostic imaging appropriate? An Australian Emergency Department pilot study

Comparison of patient flow and provider efficiency of two delivery strategies for HPV-based cervical cancer screening in Western Kenya: a time and motion study

Role of Time Study in Emergency Department of an Indian Hospital for Quality Health Care

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