Improving patient flow in an emergency department

Abstract

Background: The emergency department at Wrightington, Wigan and Leigh NHS Foundation Trust treats more than 90 000 patients every year. It is a sizable emergency department based in a large district general hospital. The department welcomes both adults and children and is also a designated major trauma unit. The case mix and demographics of these patients vary widely; however, a large proportion of these patients are elderly with multiple comorbidities. The smooth running of this emergency department depends on an unimpeded patient flow through the unit in a timely manner while ensuring that high quality care is provided. The 'initial senior assessment and treatment' model is designed to address some of the difficulties and challenges faced by the department. Methods: Two audits were undertaken four months apart in July and November 2015. In total, the first audit involved 200 adult patients, 100 of which were randomly allocated to the initial senior assessment and treatment and 100 to the non-initial senior assessment and treatment category. Patients were seen by a dedicated initial senior assessment and treatment team led by either an emergency department consultant, or an emergency department middle grade doctor. The parameters audited include: times to assessment, investigation, treatment and disposal. The second audit of 60 patients explored the staff perception to the process. In total, 20 were allocated to the initial senior assessment and treatment and 40 to the non-initial senior assessment and treatment. results: The results of both audits showed a significant reduction in all the parameters investigated; however, there was a mixed staff perception to the process. conclusion: The initial senior assessment and treatment process significantly improved the patients' journey.