EMERGENCY SERVICES IN AN EDUCATIONAL HOSPITAL: WHERE ARE THE GOLDEN TIMES LOST?
Abstract
Introduction. Emergency Departments (EO) have a highly variable workload and need to highly expertise for a critical decision making in an emergency situation. This study was designed to find some of the golden times lost in AL-Zahra Emergency department (the greatest referral emergency center in Isfahan province, affiliated to Isfahan University of Medical Sciences and Health Services).
Methods. In an observational study, we recorded all times spent by each 2212 patients referred to EO. The study was conducted in 30 days period (1999 June) and data was collected by full time secret observers.
Results. About 55.1 percent of patients came by own and others were referred by physicians or other medical centers. Forty four percent of them were managed ambulatory. About half of the admissions were during 4 to 12 PM. Mean waiting times for each stage of patient management were as follows: waiting for patient's first visit by intern of screen room, 2 min; second visits by referral intern visit, 7 min; third visit by related resident, 37 min; patient arrival at EO. till admission, 41 min; hospital registration of patient, 11 min; ordering by intern or physician, 14 min; patient arrivalat EO. till ward admission, 189 min; performing procedures for outpatient's, 95 min; patient arrival at E.O. till receiving prescription (as an ambulatory care), 97 min. Mean waiting times for preclinical procedures were: EKG, 10 min; ultrasonography, 50 min; X-ray or CT scans, 36 min and lab tests, 117 min. About 51 percent of admissions were in field of internal medicine (including neurologic and infectious disease). In 88.8 percent of the admissions, physicians who were engaged in patient screening were not matched to their specialty and expertise. Primary diagnosis was correct in 31 percent and wrong in 6 percent of hospitalized patients. In 41 percent of cases, ultimate diagnosis was obscure. The average of CPR incidence was 2.7 times per day.
Discussion. The most rate limiting stages in our E.O. were paraclinical procedures, making decision for admission and finally, registration process. Foremost of the cases, physicians who were engaged in screening process had not sufficient expertise in patient management due to inappropriate specialty and/or inadequate knowledge.
Methods. In an observational study, we recorded all times spent by each 2212 patients referred to EO. The study was conducted in 30 days period (1999 June) and data was collected by full time secret observers.
Results. About 55.1 percent of patients came by own and others were referred by physicians or other medical centers. Forty four percent of them were managed ambulatory. About half of the admissions were during 4 to 12 PM. Mean waiting times for each stage of patient management were as follows: waiting for patient's first visit by intern of screen room, 2 min; second visits by referral intern visit, 7 min; third visit by related resident, 37 min; patient arrival at EO. till admission, 41 min; hospital registration of patient, 11 min; ordering by intern or physician, 14 min; patient arrivalat EO. till ward admission, 189 min; performing procedures for outpatient's, 95 min; patient arrival at E.O. till receiving prescription (as an ambulatory care), 97 min. Mean waiting times for preclinical procedures were: EKG, 10 min; ultrasonography, 50 min; X-ray or CT scans, 36 min and lab tests, 117 min. About 51 percent of admissions were in field of internal medicine (including neurologic and infectious disease). In 88.8 percent of the admissions, physicians who were engaged in patient screening were not matched to their specialty and expertise. Primary diagnosis was correct in 31 percent and wrong in 6 percent of hospitalized patients. In 41 percent of cases, ultimate diagnosis was obscure. The average of CPR incidence was 2.7 times per day.
Discussion. The most rate limiting stages in our E.O. were paraclinical procedures, making decision for admission and finally, registration process. Foremost of the cases, physicians who were engaged in screening process had not sufficient expertise in patient management due to inappropriate specialty and/or inadequate knowledge.
Keywords
EMERGENCY DEPARTMENT, QUALITY OF SERVICES, QUALITY OF CARE, EDUCATIONAL HOSPITAL