A study of factors influencing ED patients' length of stay at one community hospital.
OBJECTIVE In 1993 the administration of Kennewick General Hospital selected a facilitator to assist an ED task force in isolating and testing aspects of operations for quality improvement. The primary problem selected was reducing the length of stay (LOS) for patients. The department had an annual census in excess of 33,000, with seven rooms and 96 hours of registered nurse staffing per day. METHODS The task force selected 11 factors considered to possibly reduce LOS. The Taguchi method of robust quality improvement, an engineering quality improvement method, was used to determine the best average impact for each factor. Testing was conducted for an 11-day period. RESULTS The top three factors with significant impact on decreasing patient LOS were adding an additional physician, an additional laboratory professional, and implementation of a policy that allowed the emergency physician to hold a patient for possible admission in an inpatient unit while attempting to locate and communicate with the patient's private physician. DISCUSSION The study results met some expectations but also provided some unexpected findings for the ED staff. Some factors were implemented to reduce patient LOS and others for a different improvement value to patient care (i.e., a private triage room). Some highly effective factors were not implemented because of significant changes in department volume.
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D001509:Bed Occupancy; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D006302:Health Services Research; D006764:Hospitals, Community; D006801:Humans; D007902:Length of Stay; D017749:Total Quality Management; D014850:Waiting Lists