Student Dissertation

Agency : Emergency Department; Turnaround Time; Gap Analysis; Patient Satisfaction

Objective : This study was undertaken with the following objectives: • To study the process flow of emergency department. • To determine the TAT of patients at ER. • To perform a gap analysis of the process.

Background : Turnaround Time (TAT) for Emergency department is taken as the time from patient arrival to either bed allotment or discharge as reflected in the system. Walrath JM, Maguire JM (2004) opined that “In the department examined it is defined as the time from patient arrival to either discharge or hospitalization. The measurement of turnaround time is a helpful variable of efficacy which is feasible in most emergency departments. Measuring turnaround times may have two major goals: improving the medical care delivered within reasonable time and taking care of for patients' satisfaction.” According to Baker B, Rochon J. (1989), “Turnaround time is an important parameter that strongly influences patients and staff satisfaction in the emergency department and there are early reports considering this important issue.” According to Kar, Datta and Ahmed (2015) “Turnaround Time (TAT) of patients shifted to ICU from Emergency department is of outmost importance as delay in transfer is associated with increasing mortality as shown in different studies. The longer the patient stays in ER the more likely their care could be compromised.” Long length of stay in ER can lead to decreased patient satisfaction, revenue loss for the hospital, compromised care for patients with acute illness and employee dissatisfaction.

Methodology : A prospective observational study was carried out during the period of March 24, 2017 to April 24, 2017 at a Tertiary Care hospital in Delhi NCR. The data collected was both primary and secondary. Primary data was collected for the patients arriving at the Emergency Department, by direct observation while the secondary data was collected with the form the Hospital Information system and the ER register. The sample considered was 172 based on convenience sampling. The study was carried out by recording the findings in a self-structured ER list. Data Analysis was done through advanced Microsoft Excel functions.

Findings : 28% of the cases (i.e. 48 cases) recorded a TAT of more than 4 hours with an average TAT of 6 hours i.e. an average delay of 2 hours. Of all the delayed cases, 37% were cash & TPA patients while 67% of patients belonged to PSU. The major factors identified for an increase in Turnaround Time were non- availability of beds in 81% of the cases, delay from investigations in 25% of the cases and communication failure between nursing and the front office staff in 19% of the cases. Delays in patient transfer were caused due to non-availability of GDAs in 43% of the cases and non-availability of nurses in 28% of the cases while housekeeping related issues and lack of coordination between nursing and admission staff was observed in 10% and 12% of cases respectively.

Recommendations :Causes that delayed the Turnaround time of patients in ER were non- availability of beds, delay in investigations and communication failure between nursing and the front office staff. While other reasons like GDA, nursing and housekeeping related issues further delayed the shifting of patient from ER, leading to an increase in the length of stay for patients. Addressing these factors would decrease the TAT to an optimum level.