Reducing Length of Stay in the Emergency Department

NCT ID: NCT03185533

Last Updated: 2017-06-14

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

72000 participants

Study Classification

OBSERVATIONAL

Study Start Date

2015-01-01

Study Completion Date

2015-12-31

Brief Summary

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Emergency department (ED) crowding has become an international challenge in the recent decades.

Length of stay (LOS) is a useful marker to monitor ED crowding. Searching for the possible causes and reducing barriers may have the greatest impact on EDLOS.

Therefore, the investigators assembled a multidisciplinary team for improvement of the ED process, to undergo assessments of ED patient flow with the spirit of lean-sigma methodologies. The objectives of this study were to evaluate a Lean-sigma-based initiative to lessen EDLOS.

Detailed Description

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Lean aims to smooth out the workflow and to eliminate wastes. In the ED settings, lean principles can display the process of the ED patient flow. Six sigma, a complementary strategy, has the merit to compensate the potential weakness of Lean through a data-driven process. Currently, a combination of Lean and Six sigma methodologies develops to solve the problems of workflow.

It became clear that concurrent multifaceted interventions were needed to reduce EDLOS. Therefore, the investigators assembled a multidisciplinary quality improvement team for improvement of the ED process, to undergo assessments of ED patient flow with the spirit of lean-sigma methodologies. The objectives of this study were to evaluate a Lean-sigma-based initiative to lessen EDLOS.

Conditions

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Length of Stay

Study Design

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Observational Model Type

CASE_ONLY

Study Time Perspective

PROSPECTIVE

Study Groups

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to reduce ED length of stay

to reduce ED length of stay to lessen ED crowding by using Lean-sigma management and quality improvement interventions including reducing boarding time and medical decision time.

Quality improvement (QI) interventions

Intervention Type BEHAVIORAL

1\. The ED admissions exhibited prolonged length of stay.

2\. The Interventions for Reducing Medical Decision Time:

1. The ED director created QI education sessions and reported monthly QI outcomes.
2. The ED nurses reported the current number of ED admission patients twice a day to the director. The director summarized the bed requests to the administrative personnel.
3. The nurses reported the in-scene complicated cases to the ED director. The director would give an assistance in managing these cases.

3\. The Interventions for Reducing Boarding Time

1. The ED patients could be admitted before 8 a.m. if the bed was vacant.
2. The ED director initiated an on-line meeting at 8 a.m. and 4 p.m.
3. Monthly QI outcomes were reported in the hospital affairs meeting.

Interventions

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Quality improvement (QI) interventions

1\. The ED admissions exhibited prolonged length of stay.

2\. The Interventions for Reducing Medical Decision Time:

1. The ED director created QI education sessions and reported monthly QI outcomes.
2. The ED nurses reported the current number of ED admission patients twice a day to the director. The director summarized the bed requests to the administrative personnel.
3. The nurses reported the in-scene complicated cases to the ED director. The director would give an assistance in managing these cases.

3\. The Interventions for Reducing Boarding Time

1. The ED patients could be admitted before 8 a.m. if the bed was vacant.
2. The ED director initiated an on-line meeting at 8 a.m. and 4 p.m.
3. Monthly QI outcomes were reported in the hospital affairs meeting.

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* the patients were registered in the ED from Jan, 2015 to Dec, 2015.

Exclusion Criteria

* the patients were excluded because of left without seeing a physician.
Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Taiwan University Hospital Hsin-Chu Branch

OTHER

Sponsor Role lead

Responsible Party

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Wan-Ching Lien

Director, Department of Emergency Medicine, NTUH Hsin-Chu branch

Responsibility Role PRINCIPAL_INVESTIGATOR

Other Identifiers

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105-061-E

Identifier Type: -

Identifier Source: org_study_id

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