No waiting lying in a corridor: a quality improvement initiative in an emergency department (28 August 2023)

Summary

Overcrowding in the emergency department (ED) is a global problem that causes patient harm and exhaustion for healthcare teams. Despite multiple strategies proposed to overcome overcrowding, the accumulation of patients lying in bed awaiting treatment or hospitalisation is often inevitable and a major obstacle to quality of care. This study in BMJ Open Quality looked at a quality improvement project that aimed to ensure that no patients were lying in bed awaiting care or referral outside a care area.

Several plan–do–study–act (PDSA) cycles were tested and implemented to achieve and maintain the goal of having zero patients waiting for care outside the ED care area. The project team introduced and adapted five rules during these cycles:

1. No patients lying down outside of a care unit
2. Forward movement
3. Examination room always available
4. Team huddle
5. An organisation overcrowding plan

The researchers found that the PDSA strategy based on these five measures removed in-house obstacles to the internal flow of patients and helped avoid them being outside the care area. These measures are easily replicable by other management teams.