PATIENT FLOW AND WAITING TIME IN EMERGENCY DEPARTMENT OF TERTIARY HEALTH CARE HOSPITALS OF KHYBER PAKHTUNKHWA

Abstract

Background: The sudden occurrence of a disaster leads to considerably high impact on population's health and on the capacity of health system to respond to the sudden surge of affected population. Emergency departments EDs play an important role in managing patients and providing high quality care in complex situations. Pre existing bottle necks in the emergency service delivery reduces the existing surge capacity of system and renders ED inefficient in providing timely and quality care to patients affected by the disaster. The understanding of patient flow by the hospital can improve the overall efficiency of operations on day to day basis and emergency response. Methodology: This was a cross sectional survey involving all the tertiary care hospitals of Khyber Pakhtunkhwa province of Pakistan. 910 patients were selected using non probability sampling and patient's progress through ED was mapped and timed from the entry to discharge or admission. Results: Major bottle necks identified during process mapping were overcrowding and long waiting times. Median processing time from entry to disposition was 50 mins (IQR 28-72). The median service time experienced by the patients during their treatment in the ED was 15 mins (IQR 15-28.75 min). Overall median waiting time for all processes through which patients passes during their visit to ED was 26 mins (IQR 14-40 mins). The patients who required diagnostic tests (lab, radiology, EG etc) had significantly higher (p=0.00) median waiting time 41 (IQR 32-51) mins. Conclusion: When process mapping is conducted properly, it proves to be a valuable tool for service improvement by identifying flaws in flow of patients, potential bottle necks and duplicate processes. Improving flaws in patient flow can improve patient waiting time which in turn can improve hospital's existing surge capacity.