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Waiting management at the emergency department - a grounded theory study
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
2013 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 13, 95- p.Article in journal (Refereed) Published
Abstract [en]

Background: An emergency department (ED) should offer timely care for acutely ill or injured persons that require the attention of specialized nurses and physicians. This study was aimed at exploring what is actually going on at an ED. Methods: Qualitative data was collected 2009 to 2011 at one Swedish ED (ED1) with 53.000 yearly visits serving a population of 251.000. Constant comparative analysis according to classic grounded theory was applied to both focus group interviews with ED1 staff, participant observation data, and literature data. Quantitative data from ED1 and two other Swedish EDs were later analyzed and compared with the qualitative data. Results: The main driver of the ED staff in this study was to reduce non-acceptable waiting. Signs of non-acceptable waiting are physical densification, contact seeking, and the emergence of critical situations. The staff reacts with frustration, shame, and eventually resignation when they cannot reduce non-acceptable waiting. Waiting management resolves the problems and is done either by reducing actual waiting time by increasing throughput of patient flow through structure pushing and shuffling around patients, or by changing the experience of waiting by calming patients and feinting maneuvers to cover up. Conclusion: To manage non-acceptable waiting is a driving force behind much of the staff behavior at an ED. Waiting management is done either by increasing throughput of patient flow or by changing the waiting experience.

Place, publisher, year, edition, pages
2013. Vol. 13, 95- p.
Keyword [en]
Waiting, Management, Emergency department, Grounded theory, Focus group, Participant observation
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-200118DOI: 10.1186/1472-6963-13-95ISI: 000317462000002OAI: oai:DiVA.org:uu-200118DiVA: diva2:622407
Available from: 2013-05-21 Created: 2013-05-20 Last updated: 2017-12-06Bibliographically approved
In thesis
1. Patient Safety in the Emergency Department: Culture, Waiting, and Outcomes of Efficiency and Quality
Open this publication in new window or tab >>Patient Safety in the Emergency Department: Culture, Waiting, and Outcomes of Efficiency and Quality
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis was to investigate patient safety in the emergency department (ED) and to determine whether this varies according to patient safety culture, waiting, and outcomes of efficiency and quality variables.

I: Patient safety culture was described in the EDs of two different hospitals before and after a quality improvement project. The questionnaire “Hospital Survey on Patient Safety Culture” was used to investigate the patient safety culture. The main finding was that the staff at both hospitals scored more positively in the dimension Team-work within hospital after implementing a new work model aimed at improving patient flow and patient safety in the ED. Otherwise, we found only modest improvements.

II: Grounded theory was used to explore what happens in the ED from the staff perspective. Their main concern was reducing patients’ non-acceptable waiting time. Management of waiting was improved either by increasing the throughput of patient flow by structure pushing and by shuffling patients, or by changing the experience of waiting by calming patients and by feinting to cover up.

III: Three Swedish EDs with different triage models were compared in terms of efficiency and quality. The median length of stay was 158 minutes for physician-led team triage compared with 243 and 197 minutes for nurse–emergency physician and nurse–junior physician triage, respectively. Quality indicators (i.e., patients leaving before treatment was completed, the rate of unscheduled return within 24 and 72 hours, and mortality rate within 7 and 30 days) improved under the physician-led team triage.

IV: Efficiency and quality variables were compared from before (2008) to after (2012) a reorganization with a shift of triage model at a single ED. Time from registration to physician decreased by 47 minutes, and the length of stay decreased by 34 minutes. Several quality measures differed between the two years, in favour of 2012. Patients leaving before treatment was completed, unscheduled return within 24 and 72 hours, and mortality rate within 7 and 30 days all improved despite the reduced admission rate.

In conclusion, the studies underscore the need to improve patient safety in the ED. It is important to the patient safety culture to reduce patient waiting because it dynamically affects both patients and staff. Physician-led team triage may be a suitable model for reducing patient waiting time and increasing patient safety.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2014. 100 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1009
Keyword
Emergency department, physician, triage, teamwork, HSOPS, grounded theory, waiting, patient safety, culture
National Category
Other Medical Sciences not elsewhere specified
Research subject
Health Care Research
Identifiers
urn:nbn:se:uu:diva-223987 (URN)978-91-554-8971-7 (ISBN)
Public defence
2014-08-29, Aulan, Ingång 21, Västmanlands sjukhus, Västerås, 13:15 (Swedish)
Opponent
Supervisors
Available from: 2014-05-28 Created: 2014-04-29 Last updated: 2014-06-30Bibliographically approved

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Burström, LenaEngström, Marie-Louise

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