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Effect of hospital interventions to improve patient flow on emergency department clinical quality indicators
  1. Simon Sethi1,
  2. Caroline Boulind1,
  3. Julie Reeve1,
  4. Amanda Carney1,
  5. Stevan Bruijns1,2
  1. 1 Executive Department, Yeovil District Hospital NHS Foundation Trust, Yeovil, UK
  2. 2 Division of Emergency Medicine, University of Cape Town, Cape Town, Western Cape, South Africa
  1. Correspondence to Stevan Bruijns, Division of Emergency Medicine, University of Cape Town, Cape Town 7925, Western Cape, South Africa; Stevan.bruijns{at}


Introduction The Royal College of Emergency Medicine highlights poor flow through hospitals as a major challenge to improving emergency department flow. We describe the effect of several hospital-wide flow interventions on Yeovil District Hospital’s emergency department flow.

Methods During 2016, a design science research study addressed several areas disproportionally contributing to exit block within Yeovil District Hospital. In this follow-up study, we used a retrospective, before/after design, to describe the effect of these interventions on the ED. We used the Royal College of Emergency Medicine’s clinical quality indicators (4-hour standard, time to decision-maker, 7-day unplanned reattendance, left without being seen, ambulatory patient care and patient experience). Pearson correlation coefficient (r) was used to compare variables. Wilcoxon signed-rank test was used to compare performance before and after the intervention.

Results Yeovil District Hospital emergency department was attended by 160 373 patients between August 2015 and October 2018. Mean monthly attendance was 4112 (±342) patients, mean age was 43 (±28) years with equal male/female split (49/51%). The 4-hour standard made a recovery from 92% to 97% (p=0.01) that did not correlate with a recovery in national data (r=0.09); this despite rising attendances both at Yeovil and nationally (r=0.75). All clinical quality indicators improved significantly (except unplanned reattendance and patient feedback which improved but not significantly).

Discussion The positive effect on emergency department clinical quality indicators reveals the beneficial impact of improving in-patient flow. Qualitative research is needed to better understand facilitators and barriers to flow improvement work. 

  • crowding
  • quality improvement
  • care systems
  • access to care
  • emergency care systems

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  • Handling editor Kirsty Challen

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  • Contributors SS, CB and SB conceived the study. CB and SB designed the study. SS, CB, AC and JR acquired the data. SB performed the data analysis. SS, CB and SB interpreted the data for the work and SB wrote the first draft. All authors contributed to revising the work critically for content and approved the version to be submitted. All authors agreed to be accountable for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. Deidentified data are available upon reasonable request from the corresponding author.