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0 20 40 60 80 100
waiting for a vacant in-patient bed: 561.17
Total ED observation room LOS: 1918.95 hrsMajor waste time: ...
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Emergency Department overcrowding and increased length of stay: Identifying the causes in a secondary care general hospital

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Poster presented at International Conference of Emergency Medicine and Public Health 2016 – Qatar

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Emergency Department overcrowding and increased length of stay: Identifying the causes in a secondary care general hospital

  1. 1. 0 20 40 60 80 100 waiting for a vacant in-patient bed: 561.17 Total ED observation room LOS: 1918.95 hrsMajor waste time: 1078.98 hrs waiting for a consultation reply 143.52 waiting to execute Rad request 143.42 get Lab report 74.75 get Rad report 63.58 review Lab results 62.92 review Rad report 29.62 4 50 100 150 200 250 300 350 Missed 01:00 02:00 03:00 04:00 05:00 06:00 07:00 08:00 09:00 10:00 11:00 12:00 13:00 14:00 15:00 Variables 7 136 232 340 247 168 60 44 24 19 18 7 10 4 20 94 LOS intervals in hours Numberofpatients Emergency Department overcrowding and increased length of stay: Identifying the causes in a secondary care general hospital Hossam Elamir,MSc, TQMD, MBBCh Department of Quality and Accreditation, MKH, MOH, Kuwait Institute of Leadership, Royal College of Surgeons in Ireland, Bahrain I. Background The author’s hospital is the only general hospital in the health area.It provides secondary and some tertiary healthcare services to 880,235 people from 13 residential areas in Kuwait. [1] The hospital has a total of 734 beds and approximately 3,000 staff in 25 different departments. Of these,9 are clinical departments,7 provide clinical support services,5 provide non-clinical support and 4 provide administrative and technical support.Emergency Department (ED) is amongst the most crucial departments in the hospital.It receives around 1000 patient/day. ED overcrowding (EDOC) and increased Length of Stay (LOS) are key global issues for more than 20 years,as they have serious repercussions. [2,3] Emergency Department (ED) overcrowding (OC) is defined as a situation where the demand for services exceeds the capacity of the department to provide them in a high quality and timely manner, [2] and associated with increased ED Length of Stay (LOS) of some patients beyond the accepted limit that varies from above 4 hours in UK to above 8 hours in Australia. [3] ED staff of the general hospitals in Kuwait and ED patients are reporting a progressively increased EDLOS and EDOC (Fig.1).No measurements have been done to assess the situation nationally. The study used direct observation for seven days,starting 26 November to 2 December 2014, to collect patient flow data (Fig. 2) on ED patients at a governmental hospital in Kuwait.It calculated wait times and services to identify the major causes of EDOC and increased LOS. Fig. 1: The Overcrowded ED Room Fig. 2: High-level flow diagram of ED visit Fig. 3a: Categorisation of patient visits to ED during 7 days Fig. 3b: Number of patients in every LOS interval Fig. 4: Percentage of the aggregated time of the 210 patients Fig. 5: The aggregated LOS and waiting times in hrs (of LOS > 6 hrs) IV. Conclusions V. References II. Methods I would like to acknowledge the help provided by my colleagues: Abeer, Amal, Lea, Manar and Rinto, the quality nurses of MKH, MOH, Kuwait For further information: Mobile: 00965-65198442 - E mail: dr_hossam_elamir@hotmail.com Linkedin URL: kw.linkedin.com/pub/hossam-elamir/b2/97b/296 1. PACI.(2014).Gender By Nationality and Age and Governorate.Retrieved January 2,2015,from http://stat.paci.gov.kw/ englishreports/#DataTabPlace:ColumnChartGendrGov 2. Affleck A,Parks P,Drummond A,Rowe BH,Ovens HJ.Emergency department overcrowding and access block.CJEM. 013;15(6):359–70. 3. Horwitz LI,Green J,Bradley EH.US Emergency Department Performance on Wait Time and Length of Visit.Annals of Emergency Medicine.2010;55(2):133–41. Around one third of the ED design capacity was utilized by 12% of the ED patients.The wasted waiting time represents 56.2% of the aggregated LOS,and access block to inpatient wards was the primary cause of increased LOS and EDOC.A national-wide measurement project should be considered to assess the exact problem volume,its impact and test solutions, which should eliminate the waits before trying to reduce the service time. VI. Acknowledgement & Contacts A total number of 6383 patient visits were registered,1750 of them were referred to the ED observation room.Among these,210 patients stayed more than 6 hours as a total ED visit time (Fig.3a-b). The aggregated time of the 210 patients was 1918.95 hours (Fig.4). III. Results Total patient visits during 7 days 6383 100% Patients who didn't go to observation 4633 73% Patients who went to observation 1750 27% Patients who deserve to be seen in observation 1434 82% Patients with cold cases 316 18% Patients who stayed less than 6 hrs 1224 70% Patients who stayed more than 6 hrs 210 12% Patient Arrival Triage Doctor room Observation room Lab/Rad request Lab/Rad done Lab/Rad result/report ED doctor Consultation request Unit doctor Admission/ discharge decision Patient transfer Further analysis revealed that they spent 1078.98 hours as major wasted waiting time.(Waiting for a vacant in-patient bed) constituted 52% of that time,(waiting for a consultation reply) constituted 13.3% and (waiting for a radiology request to be executed) constituted 13.29% (Fig.5). Total calculated ED time (by design capacity) (35 beds X 7 days)= 245 bed days Aggregated LOS time of observation room visits that deserve to be observed (1434 patients)= 221.53 days Aggregated time of +6 hrs LOS patients (210 patients)= 79.95 days the 210 patients who stayed more than 6 hrs each All other patients who stayed less than 6 hrs each 100% 90.42% 32.36% 36.08% 63.92%

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