Introduction

 Overcrowding, long waiting times, cost containment, and increasing patient demand are among the many problems encountered by the Obstetrics & Gynecology Emergency Department at Alwakra Hospital. Furthermore, long waiting times have been found to be a major cause of patients leaving without being seen (LWBS) and absconding, and many studies indicate that those who leave without being seen have an increased risk of adverse outcomes

Objectives

In this study, we will investigate the effectiveness of implementing a series of interventions in reducing waiting times in Obstetrics and Gynecology Emergency Departments (WT) from arrival to physician consultation, improving patient flow, reducing bed occupancy rates, and improving admission and discharge times.

Methodology

An analysis was performed in 2020 to determine the baseline WT duration. PDSA cycles (plan, implement, study, act) were used to implement a series of interventions, and changes in waiting time  from arrival to triage,and from triage to Physician were tracked, along with the  patient flow, Length Of stay, and number of DAMA,LWBS and Absconded in OB ED.The results of the interventions were tracked from  2021 to December 2022.

The interventions implemented were as follows:

-Implementation of pre-triage screening.

-Ensure effective communication and improve patient family education.

-Encourage patients to use emergency hotlines for any inquiry to reduce unnecessary visits to the OB ED

-Using the virtual queueing system

-Holding educational sessions on the Triage Process for Frontline Nurses..

-Implementing fast-track services for Priorities 4 and 5.

-Using electronic systems to track patient throughput.

-Effective use of available space and resources.

Results

The implementation of the new strategies has been shown to be effective in:

-Improving patient flow and reducing crowding in the waiting area and Emergency rooms.

-Reducing the average waiting time From 27 min in 2020 to 16 min only in 2022.

-Achieving and maintaining 0 minutes WT for Priority 1 and 14 minutes for Priority 2 in 2022.

-Reducing the Number of patients leaving without being seen (LWBS) From 830 cases in 2018 to 302 cases in 2022.

-The patient satisfaction rates have significantly  increased from 63% in April 2022 to 98 % in December 2022 and with Patient NPS 99%

Conclusion

The ability of the Obstetrics and Gynecology emergency department to provide exceptional quality emergency and urgent care is significantly affected by a lack of patient movement, which often leads to overcrowding.

Optimization of patient flow, improvement of health care management, reduction of unnecessary delays, improvement of quality of emergency care and patient satisfaction have been achieved through the use of a new approach with the addition of the implementation of Fast Track and Maternity Triage system in Obs & Gyn emergency department at Alwakra hospital.

 

References:

-Gilboy N, Tanabe P, Travers D, Rosenau A. Emergency Severity Index (ESI): a Triage Tool for Emergency Department Care, Version 4. 2020:1-114.

 

-Hinson JS, Martinez DA, Schmitz PSK, et al. Accuracy of emergency department triage using the Emergency Severity Index and independent predictors of under-triage and over-triage in Brazil: a retrospective cohort analysis. January 2018:1-10. doi:10.1186/s12245-017-0161-8.

 

-Rui P, Kang K. National Hospital Ambulatory Medical Care Survey: 2017 Emergency Department Summary Tables. National Center for Health Statistics.