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Abstract
Background The Royal College of Emergency Medicine has highlighted reduced patient flow through the hospital system as a major challenge to improving emergency department flow. We describe the impact of a hospital-wide flow intervention on Yeovil District Hospital emergency department’s clinical quality indicators, in order to demonstrate the value of a whole-system approach to curb access block.
Method and results We followed up on an action research study that identified and intervened on several areas within the hospital that were disproportionally contributing to access block during 2016. Using a retrospective, cross-sectional design, we described the effect of the interventions on the Royal College of Emergency Medicine’s clinical quality indicators (four-hour standard, time to decision maker, seven-day unplanned re-attendance, left without being seen, ambulatory patient care and patient experience) between January 2014 and October 2018. Pearson correlation coefficient (r) was used to compare variables and linear regression was used to describe the contribution of interventions to the change in four-hour standard.
ED attendance YDH vs national
Four hour performance YDH vs national
Time to doctor and triage
Conclusions Yeovil District Hospital emergency department was attended by 233,378 patients over the study period. Mean monthly attendance was 4,029 (±341) patients), mean age was 43 (±28) years and there was an equal male/female split (49/51%). The four-hour standard makes a gradual and consistent recovery from under 95% to over 95% that is not reflected in national data (r=0.09). This is despite a rising trend in emergency department attendances both for Yeovil and nationally (r=0.75). Other clinical quality indicators (except seven-day unplanned re-attendance) improved significantly. The overall regression model fit was R2=0.81; three interventions contributed significantly and a further two contributed non-significantly).
The impact on clinical quality indicators reveals the significant effect of a hospital-wide flow intervention that targeted multiple causes of access block. Further research should include qualitative research to understand the facilitators and barriers to flow improvement work in emergency departments.