Document Type : Original Article(s)
Authors
1 Assistant Professor, Health Services Management, Health Management and Economic Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
2 MSc Student, Student Research Committee, Health Services Management, Isfahan University of Medical Sciences, Isfahan, Iran.
3 BSc, Health Services Management, Isfahan University of Medical Sciences, Isfahan, Iran.
Abstract
Introduction: Emergency department is one of the most important hospital wards that offers emergency services to unstable patients 24 hours a day, 7 days a week. However, the way the services are offered reflects the general status of the hospital since patients with the most serious problems frequently refer to the emergency department. Emergency department waiting time is one of the indices used in evaluating hospitals. Therefore, the present study aimed to determine emergency department waiting time and to provide appropriate strategies to reduce this time at Alzahra hospital during 2009.Methods: This was a descriptive, cross-sectional study. Observations and interviews were used to collect data. Ninety-seven patients were investigated. According to the objectives of the research, waiting time was assessed by a stopwatch, a checklist and patient records. The validity of the checklist was confirmed by the experts and hospital emergency officials. Descriptive and inferential statistics were used. The data was analyzed by SPSS.Results: The mean waiting time(from entrance to the emergency department until the final visit) in the screen was 8.41 ± 5.19 minutes. About 74.2% of patients waited for less than 10 minutes. Patients had to wait for their order to be checked by the admission nurses, as the first clinical practice, for an average of 48.72 ± 42.53 minutes. The mean waiting time from the physician's order until admission to the paraclinical units including electrocardiography, radiography, CT scan, sonography and laboratory, was 59.2 ± 46.26 minutes. The mean length of stay in the emergency department was 353.1 ± 249.2 minutes. However, 39% of patients stayed less than 4 hours. T-test revealed significant relations between the type of disease (internal diseases, surgery) and waiting time at electrocardiography (P = 0.02) and sonography (P = 0.04) units.Conclusion: Since the screening was done for patients without any particular prioritization, it is necessary to establish a triage system in the emergency department of Alzahra hospital. Comparing mean waiting times to receive paraclinical services demonstrates the gap between the present status and available standards and highlights the serious need for paraclinical service process improvement. In order to prevent overcrowding, proper strategies are required to be used including prioritizing beds for emergency and non-emergency hospitalization, having an admissions coordinator, following the 30-minute rule, establishing a holding unit, direct admission of the patients, and scientific review of the number of CCU and ICU beds.Keywords: Emergency Medical Services; Hospital Department; Indicator.
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