AMHARA HEALTH BUREAU FINOTE

SELAM GENERAL HOSPITAL

EMERGENCY DEPARMENT QUALITY
IMPROVEMENT PROJECT

July/2016 EFY.
Finote Selam ,Ethiopia
EMERGENCY DEPARTMENT QI TEAM MEMBERS
No Name Responsibility Sign
1. Dr.Fikremariam Leader

2. Abdu Yibrie Member

3. Yibeltal Getie Member

4. Habtamu Tadele Member

5. Habtam Mulu Member

6. Azanaw Shiferaw Member

7. Nurit Ibrahim Member

8. Mandefro Molla Member

PDSA Cycle # 1
1. High Emergency department patient waiting more than 24
hrs.

Problem: -Waiting more than 24 hrs in an emergency department can have

serious consequences for patients, staff and the healthcare system.It impairs
patient flow, causes overcrowding, and delay patient outcomes.
 Chapter 1.Background
Finote selam General Hospital found in Amhara regional state, west Gojjam zone, located
387 Km from Addis Ababa, 176 Km from Bahir Dar. The hospital was constructed in 1954
E.C to treat tuberculosis and leprosy. It was expanded in 1976 E.C with the participation of
the local community as primary hospital .In 2012 E.C, it was upgraded as a general hospital.
Currently works with 395 staffs from these 294 of them are clinical staffs, 101 of them are
administrative and supportive staffs. Hospital serves for around 1.5 to 2.0 million population.
The hospital gives service for 400-600 patients per day.

Emergency department staffs “12” nurse proffessionals, “3” EMT, “1” ECCN & “3” GPs.ED
serves ~ 1569 cases/month (149.2%).

Services at ED;

 Triage ( Adult, ETAT)

 OPD (medical, surgical, pediatrics)
 24 hrs stay (waiting) service
 Laboratory service
 Pharmacy service

Emergency department overcrowding is a significant issue that can lead to delayed care,
increased risk of adverse outcomes, and poor patient satisfaction. Long stays in the ED,
particularly those exceeding 24 hours, are often indicative of bottlenecks in patient flow, such as:

 Delayed diagnostics and consultations

 Inadequate inpatient bed availability
 Inefficient discharge processes
 Lack of care coordination

Reducing long ED stays can improve both patient satisfaction and clinical outcomes, while
optimizing resource utilization and reducing healthcare costs.

Importance
Reducing waiting times of more than 24 hours in an emergency department (ED) is crucial for
improving patient outcomes, staff well-being, and the overall efficiency of healthcare systems.

Here are the key reasons why addressing this issue is essential:

1) Enhancing Patient Outcomes

 Timely Treatment: Faster care can prevent complications, reduce mortality, and improve
recovery, especially for critical conditions like strokes, heart attacks, or infections.
 Reduced Health Deterioration: Delayed care increases the risk of conditions worsening,
leading to prolonged hospital stays and poorer prognoses.

 Improved Patient Satisfaction: Shorter wait times enhance the patient experience and trust in
the healthcare system.

2) Reducing Overcrowding and Bottlenecks

 Efficient Patient Flow: Quicker turnover ensures emergency beds and resources are available
for new patients.

 Minimizing Ambulance Delays: Faster admission and discharge free up emergency

resources, reducing delays in ambulance response times.

3) Preventing Staff Burnout

 Improved Work Conditions: Reducing overcrowding allows healthcare staff to focus on

providing quality care rather than managing excessive workloads.

 Lower Error Rates: Less fatigue and stress among staff minimize the likelihood of mistakes
in diagnosis or treatment.

4) Economic and Operational Benefits

 Cost Savings: Early intervention prevents complications that require expensive treatments or
prolonged hospital stays.

 Resource Optimization: Efficient ED operations improve resource utilization, reducing

strain on hospital infrastructure.

5) Upholding Ethical and Legal Standards

 Patient Rights: Prolonged waits can violate patients' rights to timely and adequate care.

 Legal Compliance: Healthcare institutions are often mandated to meet specific standards for
emergency care delivery.

6) Enhancing Public Trust in Healthcare

 Reputation Management: Reducing extreme waiting times demonstrates commitment to

quality care, enhancing public confidence in the system.

 Positive Outcomes: A responsive ED reflects a well-functioning healthcare system,

improving community health outcomes.

Reducing emergency department wait times requires strategic planning, investment in resources,
and systemic improvements to ensure timely, high-quality care for all patients.
Challenges
Reducing emergency department (ED) waiting times of more than 24 hours is a significant
challenge due to various systemic, operational, and resource-related factors.

Below are the key challenges:

1) Limited Hospital Capacity

 Bed Shortages: A lack of inpatient beds often leads to "boarding" patients in the ED,
delaying transfers and increasing wait times.

 Overcrowding: High patient volumes, particularly during peak times or seasonal surges, can
overwhelm ED capacity.

2) Staffing Constraints

 Insufficient Staff: A shortage of doctors, nurses, and support staff can slow down patient
assessments, treatments, and discharges.

 Burnout and Fatigue: High workloads and stress among ED staff can reduce efficiency and
productivity.

3) Systemic Inefficiencies

 Triage Bottlenecks: Ineffective triage processes can lead to delays in prioritizing and treating
critically ill patients.

 Poor Integration with Other Departments: Delays in diagnostic services (e.g., lab results,
imaging) or specialist consultations can prolong stays.

4) Increase in Non-Emergency Visits

 Inappropriate ED Use: Patients with non-urgent conditions often use the ED as their primary
healthcare provider, adding to the workload.

 Lack of Alternative Care Options: Limited access to primary care or urgent care clinics
forces patients to seek treatment in the ED

5) Financial Constraints

 Budget Limitations: Insufficient funding for staffing, infrastructure, and technology hampers
efforts to reduce wait times.

 Resource Allocation Issues: Prioritizing other healthcare areas over ED improvements can
exacerbate delays.
6) Administrative and Policy Barriers

 Delayed Discharges: Patients who are medically fit for discharge often occupy beds while
waiting for post-hospital care arrangements, such as nursing home placements.

 Complex Admission Processes: Bureaucratic delays in admitting patients from the ED to

other hospital units prolong waiting times.

7) Patient Factors

 Complex Medical Cases: Patients with multiple chronic conditions require longer
evaluations and care, which can slow down ED operations.

 High Patient Expectations: Dissatisfaction and complaints from patients experiencing long
waits can distract staff and impact workflow.

8) External Factors

 Demographic Pressures: Aging populations increase the demand for emergency services due
to a higher prevalence of chronic illnesses.

 Pandemics and Crises: Events like COVID-19 or natural disasters significantly strain ED
resources and capacity.

Potential Solutions
Addressing these challenges requires a multifaceted approach, including:

 Expanding inpatient capacity and community-based care.

 Improving staffing levels and working conditions.

 Implementing efficient triage and discharge processes.

 Enhancing integration between emergency, primary, and specialty care.

 Investing in technology for better workflow and resource management.

 Advocating for policy changes and increased funding.

Collaboration between healthcare providers, policymakers, and communities is essential to

overcome these obstacles and improve ED wait times.
 Chapter 2.
Prioritization of the problem (Prioritize Matrix)
s/n List of Problems Government Feasibility Cost Impact Time Total
concern
1 Increased ED mortality rate 4 4 5 6 3 22

2 Poor IPC practice at ED 2 2 2 3 2 11

3 High patient waiting > 24hrs at ED 7 4 5 7 5 28

4 Poor MRC practice 3 5 4 2 3 17

5 Poor Triage system 5 4 4 6 4 23

Chapter 3.
Problem Statement:-
Emergency department overcrowding is a significant issue that can lead to delayed care,
increased risk of adverse outcomes, and poor patient satisfaction. Long stays in the ED,
particularly those exceeding 24 hours, are often indicative of bottlenecks in patient flow.

Reducing long ED stays can improve both patient satisfaction and clinical outcomes, while
optimizing resource utilization and reducing healthcare costs.

The goal is to optimize the Emergency services by addressing key challenges such as:

 Limited Hospital Capacity

 Staffing Constraints

 Systemic Inefficiencies

 Increase in Non-Emergency Visits

 Financial Constraints

 Administrative and Policy Barriers

 Patient Factors

Chapter 4.
 Aim statement
 To reduce the number of patients who stay in Finote Selam General Hospital at
Emergency Department (ED) for more than 24 hours, from 13.4% to < 1% within a
year( July/2016-July/2017 EFY).

Chapter 5
Problem Analysis:-
FISH BONE DIAGRAM STRUCTURE

People process Env’t

Staff shortages & burnout Inefficient triage process Overcrowded ED

Inadequate training: Delayed admission poor layout High

Poor communication &coordination Ineffective prioritization ED
waiting
Lack of supplies Admission policies >24hrs

Inadequate stock Lack of ED protocols

Technology policy

Figure 1, Fish bone diagram showing problem analysis and identifying causes of ED
waiting more than 24 hours in Finote selam General Hospital, 2016/2017 EFY
A Root cause analysis (RCA) is a systematic approach to identifying the primary
causes of problems or events in order to develop effective solutions. When addressing high
patient waiting in an emergency more than 24 hours, it is crucial to investigate multiple
contributing factors. Here’s a breakdown of potential root causes, organized into key categories:

1. People-related Causes

 Insufficient staff: Lack of nurses, doctors, or technicians to handle patient volume.

 Staff burnout: High levels of fatigue or stress among healthcare workers.

 Inadequate training: Staff may lack training in efficiently managing ED flow or triaging.

 Poor coordination among teams: Lack of communication between doctors, nurses, and
support staff.

 Overreliance on certain specialists: If specialists are frequently unavailable or take too

long to respond.

2. Process-related Causes

 Inefficient triage process: Triage delays lead to a backlog of patients waiting for
assessment.

 Long patient assessment times: Initial assessments and diagnostics take longer than
necessary.

 Delays in admitting patients: Bottlenecks in admitting patients to hospital beds or

specialty care units.

 Complex discharge process: Slow discharge procedures can block ED beds for incoming
patients.

 Ineffective prioritization: Low acuity patients are not prioritized properly, leading to delays
for more urgent cases.

 Inadequate patient flow management: Poor management of patient flow through different
stages of care (admission, treatment, discharge).

 Lack of electronic health records (EHR) integration: Delays in accessing critical patient
information, reducing efficiency.

3. Technology-related Causes

 Lack of critical supplies: Shortages of medications, bandages, or other medical supplies

can delay treatments.
 Inadequate stock of diagnostic tools: Insufficient availability of diagnostic kits or
medication that may delay care or discharge.

4. Environment (Physical and Organizational Setup):

 Overcrowded ED: ED is overcrowded due to seasonal surges (e.g., flu season) or

general high patient volume.
 Poor facility layout: Inefficient use of space may increase the time it takes for staff to
move between departments.
 Lack of separation between urgent and non-urgent cases: Non-urgent patients may be
mixed with critical patients, increasing wait times.
 Limited waiting area: Inadequate seating or space for patients and families can increase
patient frustration, even before treatment.

5. Policies (Hospital Regulations and Protocols):

 Admission policies: Rigid or lengthy admission criteria for transferring patients from the
ED to hospital wards.
 Insurance-related delays: Delays caused by insurance verification, authorization, or
approval for tests/procedures.
 Lack of emergency protocols: Lack of standardized protocols for handling surge
situations (e.g., mass casualty incidents or high volumes).
 Inadequate patient prioritization policies: Failure to consistently apply a structured
triage system that prioritizes patients effectively.

6. Materials (Supplies and Medication):

 Lack of critical supplies: Shortages of medications, bandages, or other medical supplies

can delay treatments.
 Inadequate stock of diagnostic tools: Insufficient availability of diagnostic kits or
medication that may delay care or discharge.
 DRIVER DIAGRAM FOR GENERATING CHANGE IDEAS
Out Come Primary Driver Secondary Driver Change Ideas
Bed Digital inventory mgx
Availability systems

Supply,space
flexible space plan
Resource optimization
Availability
Adequate Materials
Effective Staffing
Staff/training
&Workforce mgx Admission/ predictive scheduling tools

Reduce ED Waiting Optimized Discharge

Implement regular, brief
Times > 24hrs Processes/Procedur Processes
Rapid "huddles"
es Dxtic/Rx
Protocols Dedicated discharging team
Improved Patient Triage Automation
Flow Process
Optimized Fast-track
Pt Mov’t
Real-time tracking
Quick Bed
Utilization Alert bed mgx systems

By
using this Driver Diagram, the focus is placed on understanding the key drivers that contribute to
prolonged waiting times in the ED and generating actionable ideas across multiple dimensions. These
change ideas can lead to significant improvements in patient flow, staffing, processes, resources, and
communication, ultimately reducing the waiting time to under 24 hours.

CHAPTER 6: Methods
6.1. Objective: To reduce emergency department waiting more than 24 hours from 13.4% to
< 1% over the next 01year.
Reducing emergency department (ED) waiting times, especially those exceeding 24 hours, is critical for
improving patient outcomes and overall healthcare efficiency. Here are some strategies and methods to
address long waiting times in the ED:

1. Triage and Fast Track Systems

 Triage Reform: Prioritize patients based on the severity of their condition. Implement advanced
triage systems with dedicated staff to quickly assess patients and allocate resources more
effectively.
 Fast-Track System: Create a separate pathway for patients with less urgent needs (e.g., minor
injuries, routine conditions) to expedite their treatment and reduce the burden on the main ED.

2. Improved Patient Flow and Bed Management

 Discharge Planning: Proactively discharge patients who no longer require ED services. This
ensures bed availability for those with more urgent needs.
 Bed Management System: Utilize real-time bed management systems to track bed availability
across the hospital and allocate them more efficiently.

3. Use of Technology

 Electronic Health Records (EHR) and Data Analytics: Implement advanced EHR systems to
streamline documentation, reduce time spent on administrative tasks, and improve decision-
making.
 Predictive Analytics: Use predictive tools to forecast patient inflow, identify potential
bottlenecks, and allocate resources accordingly.
 Telemedicine and Virtual Triage: Allow remote consultations or assessments, especially for
non-urgent cases or follow-up visits, to free up physical space in the ED.

4. Staffing Optimization

 Adequate Staffing: Ensure the right number of healthcare professionals (doctors, nurses,
technicians) are available during peak hours. This can be managed through data analytics to
identify surge times.
 Flexible Staffing Models: Use a mix of full-time, part-time, and per-diem staff to adjust to
demand fluctuations, reducing wait times during periods of high patient volume.

5. Collaborations and Referrals

 Community Partnerships: Collaborate with primary care physicians and urgent care centers to
divert non-emergency cases from the ED.
 Pre-arranged Transfers: Establish agreements with local clinics or outpatient facilities to
transfer patients who need non-emergency care.

6. Redesigning ED Processes
  Parallel Processing: Introduce simultaneous assessments and treatments for patients when
appropriate. For instance, while waiting for imaging results, the patient may be seen by a
specialist or nurse.

7. Public Awareness and Education

 Triage Education: Educate the public on appropriate ED use, encouraging them to seek urgent
care or primary care for non-emergency conditions.
 Promote Alternate Care Pathways: Inform patients about the availability of urgent care centers,
telemedicine, and after-hours clinics for minor conditions.

8. Increase Hospital Capacity

 Expand ED Capacity: If sustained high patient volume is an issue, consider physical expansion
of the ED, or increase the number of treatment rooms to accommodate more patients.
 Increased Use of Observation Units: Create dedicated observation units for patients who need
short-term monitoring and can avoid being admitted to a hospital bed, thus freeing up ED space.

9. Patient Experience and Comfort

 Patient Flow Coordination: Appoint patient flow coordinators or navigators who can help guide
patients through the ED process and reduce delays.
 Waiting Room Management: Enhance waiting room comfort with better seating, entertainment,
and information updates to improve the patient experience while waiting.

10. Quality and Performance Monitoring

 Real-time Monitoring: Continuously monitor key performance metrics such as wait times,
patient satisfaction, and discharge rates to identify bottlenecks and optimize performance.
 Feedback Loops: Collect feedback from patients and staff to identify specific areas of
improvement within the ED.

By implementing a combination of these strategies, emergency departments can better manage patient
flow, reduce excessive waiting times, and enhance the overall quality of care.

6.2. Materials

To address the problem of excessive waiting times in the emergency department (ED), especially
those extending beyond 24 hours, a variety of materials, tools, and resources can be utilized.
These materials help streamline processes, improve patient flow, and optimize hospital
resources. Here are key materials to reduce long ED wait times:
1. Triage Protocols and Decision Support Tools

 Triage Algorithms: Standardized protocols (such as the Canadian Triage and Acuity
Scale or Emergency Severity Index) to quickly assess the severity of patients' conditions
and prioritize care accordingly.
 Decision Support Systems (DSS): Software tools integrated with electronic health
records (EHR) that assist clinicians in making quick decisions on triage and treatment,
reducing delays in patient management.

2. Patient Flow Management Tools

 Real-Time Bed Management Software: Platforms allowing hospitals to track bed

availability across departments, ensuring patients are quickly assigned to appropriate
rooms or treatment areas.
 Patient Flow Dashboards: Interactive dashboards that display live data on patient status,
ED wait times, and staffing levels, helping to optimize resource allocation and monitor
bottlenecks.
 Patient Tracking Systems: technologies to track patients and their care status
throughout the ED. This helps ensure no patient is overlooked and provides real-time
status updates.

3. Electronic Health Records (EHR) and Integration Tools

 Integrated EHR Systems: Using systems to streamline documentation, which reduces

time spent on paperwork and improves coordination between different healthcare
providers.
 Pre-Registration and Triage Integration: Allowing patients to pre-register online or
via mobile apps before arriving at the ED helps gather key information and reduces
delays at check-in.

4. Patient Education Materials

 Brochures and Posters: Information about when to use the ED, when to seek urgent
care or primary care, and the risks of excessive ED use. These can be distributed in
waiting rooms and available digitally.
 Public Service Campaigns: Campaigns to inform the public about appropriate ED use,
such as signs, flyers, or social media content targeting non-urgent conditions that could
be treated elsewhere.

5. Workforce Scheduling and Staffing Tools

  Staff Scheduling Software: Platforms like "Shiftboard" to optimize staffing levels based
on predicted patient volume, ensuring there are enough doctors, nurses, and support staff
during peak times.
 Telehealth Platforms for Virtual Triage: Tools that enable telemedicine consultations,
allowing patients to be evaluated remotely for non-urgent conditions, helping to decrease
ED burden.

6. Operational and Process Improvement Materials

 Lean Management Toolkits: Materials and guides for implementing Lean principles,
which focus on reducing waste and inefficiencies in ED workflows. For example, a Lean
toolkit can guide staff through process mapping, root cause analysis, and the elimination
of non-value-added steps.
 Flowcharting Tools: Software to map out ED processes and identify bottlenecks that
lead to delays.

7. Data Analytics and Predictive Tools

 Predictive Analytics Software: Tools that use machine learning and historical data to
forecast patient volume, waiting times, and potential bottlenecks, helping hospitals better
allocate resources.
 Real-Time Reporting Tools: Dashboards that aggregate and display patient volume,
wait times, and department status in real time. These reports help hospital leadership
make data-driven decisions to prevent overcrowding.

8. Communication Tools

 Patient Queue Management Systems: Software that help manage patient flow by
sending text updates or notifications about wait times and next steps, reducing anxiety
and improving the experience.
 Staff Communication Platforms: Instant messaging platforms for ED staff to
communicate quickly, coordinate care, and ensure efficient patient handoffs.

9. Physical Resources for ED Design and Capacity

 Modular Treatment Rooms: Temporary or mobile treatment units that can be deployed
during peak demand times to alleviate congestion in the main ED.
 Waiting Area Improvements: Comfortable seating, digital signage for real-time wait
updates, entertainment options, and quiet areas to make long waits more bearable for
patients.
 Observation Units: Dedicated spaces for short-term monitoring of patients who do not
require full inpatient admission but need extended care or observation.
 10. Collaboration Tools with External Providers

 Referral Networks: Online portals or apps that enable quick referral from the ED to
urgent care centers, primary care providers, or specialty care, reducing unnecessary ED
visits.
 Transfer Agreements and Protocols: Standardized materials that streamline the process
of transferring patients to other facilities or departments, speeding up the ED's turnover
rate.

11. Patient Feedback Mechanisms

 Surveys and Feedback Forms: Quick, digital or paper-based tools for gathering patient
feedback on their experience, identifying pain points in the ED process that contribute to
long wait times.
 Real-Time Feedback Tools: Interactive devices in the waiting area that allow patients to
rate their experience or report delays, helping staff make adjustments in real time.

12. Staff Training Materials

 Simulation Training Resources: Simulation-based learning tools that prepare staff for
high-volume situations and teach them strategies to manage patient flow effectively
during busy periods.
 Crisis Management Plans: Detailed materials that guide staff in managing surges in
patient volume, ensuring that all patients are treated in a timely manner and avoiding
prolonged waits.

Using a combination of these materials can significantly improve the efficiency of emergency
departments, reduce wait times, and improve patient satisfaction.

Emergency Department Case Flow, 2016/2017 EC.

Month No Of Attendants No Pts Waiting >24hrs Performance %(waiting)

July 1460 196 13.4

August 1577 192 12.2

September 1921 160 8.3

October 1561 36 2.3

November 1326 18 1.4

December 1414 47 3.3

January

February
 Action Plan to Reduce ED Waiting Times Exceeding 24 Hours
No Activities Responsible body Time frame
1 Assess and Address Immediate Bottlenecks ED 1-2 weeks

2 Optimize Patient Flow and Bed Management ED, liaison, wards 1-3 months

3 Improve Staffing and Technology Integration ED,SMT,HR 3-6 month

4 Reorganize ED Operations and Build External ED,SMT,GB 6-12 month

Partnerships
5 Continuous Improvement and Monitoring ED Ongoing

1. Immediate Actions: Assess and Address Immediate Bottlenecks

Timeline: 1-2 Weeks

 Data Collection: Collect real-time data on current wait times, reasons for delays, and
bottlenecks (e.g., overcrowding, staffing shortages, patient flow disruptions).
 Triage Assessment: Review current triage protocols and ensure patients are being
triaged according to severity. Implement or refine fast-track systems for less urgent cases
(e.g., minor injuries, non-urgent illnesses).
 Temporary Resource Allocation: Adjust staffing schedules to respond to immediate
surges in patient numbers, such as bringing in additional doctors, nurses, or support staff
during peak hours.
  Patient Flow Coordination: Appoint a dedicated patient flow coordinator responsible
for managing patient movement and addressing delays in real time.
 Communication with Patients: Provide frequent updates to patients waiting for long
periods, including estimated wait times and reasons for delays.

2. Short-Term Strategy: Optimize Patient Flow and Bed Management

Timeline: 1-3 Months

 Real-Time Bed Management: Implement or optimize bed management software to

track bed availability and expedite patient transfer from the ED to inpatient or
observation beds.
 Dedicated Observation Units: Establish or enhance observation units where patients
who need monitoring but not full inpatient care can be placed, reducing bed blockages in
the ED.
 Redesign ED Space: Rearrange or expand the ED physical space (if possible) to include
additional treatment areas, fast-track lanes, and dedicated spaces for less urgent patients.
 Implement Parallel Processing: Introduce parallel processes for patients (e.g., labs,
imaging, and consultations) that allow for simultaneous steps to reduce waiting times for
individual procedures.
 Discharge Management: Develop a proactive discharge strategy to ensure patients who
no longer need ED services are discharged promptly, making room for new patients.

3. Medium-Term Strategy: Improve Staffing and Technology Integration

Timeline: 3-6 Months

Staffing Optimization:

o Analyze staffing patterns and optimize schedules based on historical data to

ensure appropriate coverage during peak times.
o Use flexible staffing models, such as part-time or per-diem staff, to quickly adjust
for surges in demand.
o Provide staff with cross-training to allow for flexible role-switching during high-
demand periods (e.g., nurses trained to assist with triage).

Implementation of Predictive Analytics:

 o Deploy predictive analytics tools to forecast patient volume, enabling the ED to
anticipate surges and adjust staffing, resources, and bed availability proactively.
o Use these tools to identify patterns, such as times of the day or week with high
volumes, to optimize staff scheduling and resource allocation.

Enhance Electronic Health Records (EHR):

o Ensure EHR systems are optimized for efficiency in patient documentation,

reducing the time clinicians spend on administrative tasks and speeding up care
delivery.
o Integrate EHR with other hospital systems (e.g., lab, imaging) for faster results
and improved coordination between departments.

4. Long-Term Strategy: Reorganize ED Operations and Build External Partnerships

Timeline: 6-12 Months

Expand ED Capacity (If Possible):

o If the ED consistently operates at or beyond full capacity, explore expansion

options, such as constructing additional treatment rooms or expanding the ED
footprint to accommodate more patients.
o Consider temporary or modular treatment spaces during periods of high patient
volume.

Telemedicine and Virtual Triage:

o Integrate telemedicine services for non-urgent consultations, enabling remote

triage or follow-up visits, reducing the volume of non-critical cases in the ED.
o Use virtual waiting rooms where patients can be assessed remotely, freeing up
physical space in the ED.

Urgent Care and Primary Care Partnerships:

o Strengthen partnerships with local urgent care centers, primary care providers,
and clinics to redirect patients with non-emergency needs, thus reducing
unnecessary ED visits.
o Educate the public on when to visit urgent care or primary care centers versus the
ED to prevent overcrowding.
 o Create a seamless referral system for patients with less urgent needs to be
redirected promptly.

Community and Public Education:

o Launch a public awareness campaign that educates patients on the appropriate use
of the ED and when to seek alternatives (e.g., urgent care or telehealth services).
o Provide educational materials both online and in waiting areas, informing patients
about common conditions that can be treated elsewhere and the risks of long ED
waits.

5. Continuous Improvement and Monitoring

Timeline: Ongoing

Monitor Key Metrics:

o Track metrics such as patient wait times, length of stay, triage accuracy, bed
turnover, and patient satisfaction regularly.
o Set up daily or weekly meetings to review data and make adjustments in staffing,
processes, and procedures as needed.

Patient and Staff Feedback:

o Implement a system for gathering real-time feedback from patients (e.g., surveys
or kiosks) and staff (e.g., debriefing sessions or suggestion boxes) to identify pain
points and areas for improvement.
o Use feedback to refine processes, improve the patient experience, and reduce
delays.

Performance Review and Adjustments:

o Regularly review the performance of implemented strategies, making adjustments

to optimize their effectiveness.
o Use process improvement methodologies like Lean or Six Sigma to further
streamline ED operations and reduce inefficiencies.

6. Evaluation and Success Metrics

Key Success Indicators:

 Reduced Wait Times: Achieve a measurable reduction in the number of patients waiting
more than 24 hours, with a goal of reducing waits to under 6-8 hours for the majority of
patients.
 Improved Patient Flow: Shorten overall patient throughput time (from arrival to
discharge/admission).
 Increased Patient Satisfaction: Improved patient satisfaction scores, particularly related
to wait times, communication, and care coordination.
 Staff Satisfaction and Retention: Higher staff engagement and reduced burnout due to
better work-life balance and optimized workflows.

Conclusion

This action plan sets a roadmap for reducing ED wait times exceeding 24 hours through a
combination of immediate, short-term, and long-term strategies. By focusing on improving
triage, optimizing staffing, utilizing technology, and enhancing patient flow, hospitals can
significantly alleviate bottlenecks, improve patient care, and enhance overall efficiency in the
ED.
 Cont.…
Next to
PDSA Cycle # 2