Not all waits are equal: an exploratory investigation of emergency care patient pathways
Abstract Background Increasing pressure in the United Kingdom (UK) urgent care system has led to Emergency Departments (EDs) failing to meet the national requirement that 95% of patients are admitted, discharged or transferred within 4-h of arrival. Despite the target being the same for all acute ho...
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| Format: | Article |
| Language: | English |
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BMC
2017-06-01
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| Series: | BMC Health Services Research |
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| Online Access: | http://link.springer.com/article/10.1186/s12913-017-2349-2 |
| _version_ | 1819077665002356736 |
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| author | Dawn Swancutt Sian Joel-Edgar Michael Allen Daniel Thomas Heather Brant Jonathan Benger Richard Byng Jonathan Pinkney |
| author_facet | Dawn Swancutt Sian Joel-Edgar Michael Allen Daniel Thomas Heather Brant Jonathan Benger Richard Byng Jonathan Pinkney |
| author_sort | Dawn Swancutt |
| collection | DOAJ |
| description | Abstract Background Increasing pressure in the United Kingdom (UK) urgent care system has led to Emergency Departments (EDs) failing to meet the national requirement that 95% of patients are admitted, discharged or transferred within 4-h of arrival. Despite the target being the same for all acute hospitals, individual Trusts organise their services in different ways. The impact of this variation on patient journey time and waiting is unknown. Our study aimed to apply the Lean technique of Value Stream Mapping (VSM) to investigate care processes and delays in patient journeys at four contrasting hospitals. Methods VSM timing data were collected for patients accessing acute care at four hospitals in South West England. Data were categorised according to waits and activities, which were compared across sites to identify variations in practice from the patient viewpoint. We included Public and Patient Involvement (PPI) to fully interpret our findings; observations and initial findings were considered in a PPI workshop. Results One hundred eight patients were recruited, comprising 25,432 min of patient time containing 4098 episodes of care or waiting. The median patient journey was 223 min (3 h, 43 min); just within the 4-h target. Although total patient journey times were similar between sites, the stage where the greatest proportion of waiting occurred varied. Reasons for waiting were dominated by waits for beds, investigations or results to be available. From our sample we observed that EDs without a discharge/clinical decision area exhibited a greater proportion of waiting time following an admission or discharge decision. PPI interpretation indicated that patients who experience waits at the beginning of their journey feel more anxious because they are ‘not in the system yet’. Conclusions The novel application of VSM analysis across different hospitals, coupled with PPI interpretation, provides important insight into the impact of care provision on patient experience. Measures that could reduce patient waiting include automatic notification of test results, and the option of discharge/clinical decision areas for patients awaiting results or departure. To enhance patient experience, good communication with patients and relatives about reasons for waits is essential. |
| first_indexed | 2024-12-21T19:00:48Z |
| format | Article |
| id | doaj.art-7b90e0a1d59e4a2593bae7d05df944a8 |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-12-21T19:00:48Z |
| publishDate | 2017-06-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-7b90e0a1d59e4a2593bae7d05df944a82022-12-21T18:53:30ZengBMCBMC Health Services Research1472-69632017-06-0117111010.1186/s12913-017-2349-2Not all waits are equal: an exploratory investigation of emergency care patient pathwaysDawn Swancutt0Sian Joel-Edgar1Michael Allen2Daniel Thomas3Heather Brant4Jonathan Benger5Richard Byng6Jonathan Pinkney7Peninsula Schools of Medicine and Dentistry, University of PlymouthDepartment of Computer Science, University of BathMedical School, University of ExeterPeninsula Schools of Medicine and Dentistry, University of PlymouthSchool of Social and Community Medicine, University of BristolFaculty of Health and Applied Sciences, University of the West of EnglandPeninsula Schools of Medicine and Dentistry, University of PlymouthPeninsula Schools of Medicine and Dentistry, University of PlymouthAbstract Background Increasing pressure in the United Kingdom (UK) urgent care system has led to Emergency Departments (EDs) failing to meet the national requirement that 95% of patients are admitted, discharged or transferred within 4-h of arrival. Despite the target being the same for all acute hospitals, individual Trusts organise their services in different ways. The impact of this variation on patient journey time and waiting is unknown. Our study aimed to apply the Lean technique of Value Stream Mapping (VSM) to investigate care processes and delays in patient journeys at four contrasting hospitals. Methods VSM timing data were collected for patients accessing acute care at four hospitals in South West England. Data were categorised according to waits and activities, which were compared across sites to identify variations in practice from the patient viewpoint. We included Public and Patient Involvement (PPI) to fully interpret our findings; observations and initial findings were considered in a PPI workshop. Results One hundred eight patients were recruited, comprising 25,432 min of patient time containing 4098 episodes of care or waiting. The median patient journey was 223 min (3 h, 43 min); just within the 4-h target. Although total patient journey times were similar between sites, the stage where the greatest proportion of waiting occurred varied. Reasons for waiting were dominated by waits for beds, investigations or results to be available. From our sample we observed that EDs without a discharge/clinical decision area exhibited a greater proportion of waiting time following an admission or discharge decision. PPI interpretation indicated that patients who experience waits at the beginning of their journey feel more anxious because they are ‘not in the system yet’. Conclusions The novel application of VSM analysis across different hospitals, coupled with PPI interpretation, provides important insight into the impact of care provision on patient experience. Measures that could reduce patient waiting include automatic notification of test results, and the option of discharge/clinical decision areas for patients awaiting results or departure. To enhance patient experience, good communication with patients and relatives about reasons for waits is essential.http://link.springer.com/article/10.1186/s12913-017-2349-2Health service researchAcute careEmergency admissionsPatient careValue stream mappingEmergency department |
| spellingShingle | Dawn Swancutt Sian Joel-Edgar Michael Allen Daniel Thomas Heather Brant Jonathan Benger Richard Byng Jonathan Pinkney Not all waits are equal: an exploratory investigation of emergency care patient pathways BMC Health Services Research Health service research Acute care Emergency admissions Patient care Value stream mapping Emergency department |
| title | Not all waits are equal: an exploratory investigation of emergency care patient pathways |
| title_full | Not all waits are equal: an exploratory investigation of emergency care patient pathways |
| title_fullStr | Not all waits are equal: an exploratory investigation of emergency care patient pathways |
| title_full_unstemmed | Not all waits are equal: an exploratory investigation of emergency care patient pathways |
| title_short | Not all waits are equal: an exploratory investigation of emergency care patient pathways |
| title_sort | not all waits are equal an exploratory investigation of emergency care patient pathways |
| topic | Health service research Acute care Emergency admissions Patient care Value stream mapping Emergency department |
| url | http://link.springer.com/article/10.1186/s12913-017-2349-2 |
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