Reduced waiting times, increased resources
A rapid improvement event was organised by frontline workers to rapidly overhaul processes of care, leading to the creation of the Rapid Medical Evaluation (RME) unit – a new pathway of care for patients with lower acuity presentations.
The Toronto Western Hospital is an academic hospital in Toronto, Canada, with an annual Emergency Department (ED) volume of 64,000 patients.
Despite increases in patient volumes of almost six percent per annum over the last decade, there have been no commensurate increases in resources, infrastructure, and staffing. This has resulted in disproportionately longer wait times experienced by the lowest acuity cohort of patients.
The resultant increased the burden on ED staff and resources due to the extended length of stay for these lower acuity patients can lead to decreased morale among staff, worse care for all patients, and fewer resources and staff available per patient.
A retrospective evaluation of a quality improvement initiative was undertaken aimed at improving wait times experienced by patients with lower acuity presentations.
A rapid improvement event was organised by frontline workers to rapidly overhaul processes of care, leading to the creation of the Rapid Medical Evaluation (RME) unit – a new pathway of care for patients with lower acuity presentations. The RME unit was designed by re-purposing existing resources and re-assigning one physician and one nurse towards the specific care of these patients.
The patients seen in the RME unit saw their median physician initial assessment (PIA) times decrease from 98 minutes to 70 minutes and total length of stay (LOS) times decreased from 165 minutes to 130 minutes. Only patients for whom both PIA and LOS time were documented were included in this data.
Despite the ever-growing number of patient visits, wait time for all patients with lower acuity presentations remained low and wait times of patients with higher acuity presentations assigned to other ED care pathways were not adversely affected.
BMJ Quality Improvement Reports publishes quality improvement work, original research and reviews. The online-only, open access journal covers all aspects of quality and patient safety in healthcare.