Hospital-based continuous quality improvement: a realistic appraisal.
OBJECTIVE
To evaluate the impact of a continuous quality improvement (CQI) multidisciplinary team process on emergency department admission times.


METHODS
Prospective observational intervention study.


METHODS
A 349-bed tertiary care, university-affiliated, pediatric teaching hospital.


RESULTS
The time from triage to departure from the emergency department (T1-T3) was reduced by 71 minutes, and the time from the decision to admit to departure from the emergency department (T2-T3) by 38 minutes following the planned interventions. There was no correlation between admission times and hospital inpatient census, number of emergency department admissions on a given day, or work shift. Medical patients were transferred to the wards more slowly than patients admitted by the general surgery service and several specialty surgical services once the decision to admit had been reached. No major adverse clinical outcomes could be attributed to expedited admissions. Physicians and nurses in the emergency department expressed improved satisfaction with the admissions process, while houseofficers on the wards were less satisfied. Parental satisfaction with the speed of admissions remained suboptimal. Additional potential problems with the application of CQI principles in an academic setting were identified.


CONCLUSIONS
Although CQI is a promising approach to certain quality problems, a number of issues remain to be explored before full-scale implementation in academic centers can be endorsed.
Division of Infectious Diseases, Children's Hospital, Boston, MA 02115.
D A
DA
Goldmann
C A
CA
Saul
S
S
Parsons
C
C
Mansoor
A
A
Abbott
F
F
Damian
G J
GJ
Young
C
C
Homer
G L
GL
Caputo
D003258:Consumer Behavior; D004636:Emergency Service, Hospital / Q000592:standards* / Q000706:statistics & numerical data; D006745:Hospital Bed Capacity, 300 to 499; D006776:Hospitals, Pediatric / Q000458:organization & administration / Q000592:standards*; D006784:Hospitals, Teaching / Q000458:organization & administration / Q000592:standards; D008332:Management Quality Circles; D010343:Patient Admission / Q000592:standards* / Q000706:statistics & numerical data; D010348:Patient Care Team; D011340:Problem Solving; D013996:Time and Motion Studies; D017749:Total Quality Management / Q000458:organization & administration*; D014218:Triage; D014481:United States