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Assistance Quality and Operational Efficiency: Challenge in the Emergency Department

Introduction: The Health Institutions intend to improve your results more and more, likewise to ensure your competitive, financial sustainability and assure the quality and security in your provision of services, seek to implement strategies that lead to reduction of costs and better use of resources. The actual challenge is to implement improvements and changes capable to produce better results in the assistance at the lowest cost, to promote the assistance quality and safety in order to adapt the patients' needs and generate the best experience and the best outcome. In the services of urgency and emergency, standardize process and protocols of care, suit the patients flow, create personalized and humanized service. Besides better qualification of the professionals, these are some strategies that have increased the performance and production of these services and generated value to the patient. The objective of this study is evaluate the operational, financial, quality and security results after the restructuration of Emergency Department.

Methods: Intervention study to evaluate the quality of service of the adult emergency care in a private and tertiary hospital. The referential proposed by Donabedian (1980) was used, considering (Figure 1): structure (Emergency room capacity and beds for non-urgent patients, care and support staff, physical and technological infrastructure); process (capacitation of the nursing staff for risk classification – Manchester Protocol, enhancement in the  flow of service – fast track, insertion of a professional controller of the flow of patients, capacitation of the staff for a assistance model  based in equity principals and centralized on the patient and family); results (production, operational efficiency indicators, assistance and client satisfaction). Statistical tests were applied (Student t, X2), considering 95% CI and significance level p <0.05.

Results: Were invested around 1,9 million Reais in infrastructure, technology and human resources during the intervention period (March to December 2016). The same ten months of 2015 were compared, finding: a significant increased by 6,6% the number of attendance (p=0.018), 16% reduction in the average time for medical evaluation during the attendance on rush hour (10h-21h) (p=0.079), 4% reduction in the average permanency time (p= 0,093), increased by 49% in EBITDA, 42% reduction in the evasions (p<0.01); 10% increase in risk rating accuracy and reduction in readmissions by 7% in 48 hours (p <0.01) (Table 1). A new model of patient satisfaction (Net Promoter Score) was implemented from June 2016 and it increased by 19% from June to December 2016.

ConclusionsThe best utilization of internal resources, adequacy of processes and appropriate interventions can lead the service to more efficient results. In addition to increasing patient safety and ensuring better clinical effectiveness, also obtaining better assistance results. Focusing attention on patient and family providing immediate attendance, at the correct time with diagnostic accuracy in addition to competent professionals, guarantee better health outcomes and better patient experience

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