How to Reduce Patient Waiting Time in Emergency Medicine Services - Thesis Proposal Example

Shum Daas Master of Health Administration’s Sponsored by King Saud Riyadh.  Faculty of Health Sciences.  Health Administration Department  Research Proposal On How to Reduce Patient Waiting Time in the Emergency Medicine Services in King Faisal Specialist Hospital & Research Centre- Riyadh. 1. Introduction Saudi Arabia is prominent country of the South East Asia with Islamic culture. In the last 30 years, it has undergone tremendous transformation in almost all areas of public concern vis-à-vis health, education, transport, environment and infrastructure development. Public health and local economy have been major areas of development. The upsurge in the expatriate population has increased the burden on healthcare industry. King Faisal Specialist Hospital and Research Centre in Riyadh, capital of Saudi Arabia has been one of the key hospitals that has, in the recent times been faced with increasingly long queues. It has become a major concern as it impacts level of service and quality. It has especially become important to reduce patient waiting time in emergency medicine services. The research study would address the problem and make recommendations for improving it. 2. Goals The key objective of the study would be to analyze and evaluate the causes of long queues of patients and make recommendations to reduce patient wait time. Thus the broader objective would be to suggest ways that would improve emergency health services or EMS in the King Faisal Specialist Hospital. 3. Research Rationale King Faisal Specialist Hospital is a 750 bed multi-specialty oncology hospital in Riyadh, the capital city of Kingdom of Saudi Arabia. Emergency Medicine Services Department has 32 beds. However, due to the increased demand for services, as the hospital manages large number of patients, issues and concerns have been raised by the emergency patients with regard to the services provided by the hospital.  The long queues and delay results in low quality of patient care and adversely impacts staff recruitment and retention (Pearce, 2002; Derlet and Richards, 2000). 4. Literature review Various scholars have asserted that waiting time is the most important cause of dissatisfaction of patients attending emergency departments (Trout et al., 2000). It is observed that patients with long wait list often leave without seeing specialist and therefore aggravates their illnesses leading to emergency situation. This delay is critical aspect that has been associated with adverse outcomes and increased violence in emergency departments (Stirling et al., 2001; Derlet and Richards, 2000).  A study by Witt (1995) revealed that transcription of notes can improve the productivity of the emergence department by 3.8%. Interestingly another study by Bond (2001) indicated reduced waiting time from 58 minutes to 25 minutes by diverting medical staff to the triage area. Indeed, reducing waiting time for patients becomes one of the most important factor for improved healthcare services (Cooke and Jenner, 2002). The various ways and mechanisms of reducing wait time and improving emergency medical services therefore would be evaluated for the hospital. 5. Methods This study will be a descriptive study conducted at King Faisal Specialist Hospital-Riyadh. Data will be collected from the registration log book of the patients who visit the EMS during the data collection proposed period for the study. SPSS or EpiData would be used to analyze the data. In King Faisal Specialist Hospital-Riyadh, patients follow a complex pathway through the emergency department.  Hence, qualitative as well quantitative analysis would be carried out. The method would primarily focus on the following areas of concern: 5(a) Main causes of waiting Many perspectives would be used to identify the main causes of increasing wait list and wait time of patients in emergency services. Causes like long documentation, lack of inpatients beds in emergency department, lack of skilled staff, low retention, increased number of patients in Ramadan, large cases due to hot weather conditions etc. would be evaluated for their efficacy in increasing patients’ queue. 5(b) Effects of delays and overcrowding Overcrowding in emergency section not only adversely influences the healthcare delivery and patient care but also increases the risk in the patients health. The various effects of delays therefore become critical issue within the emergency department and study would identify and evaluate so that they can be addressed within recommendations. 5(c) Ways to reduce patient waiting time in the EMS This is major part of study and methodology that would be used to analyze various factors and issues so as to evolve new approach and mechanisms to improve healthcare services of the hospital with main focus on reduction in patient wait time in emergency medical services. 6. Key Stakeholders The key stakeholders of the study would be the various clerical, administrative and managerial staff of EMS including nursing staff, consultants for pediatrics and adult staff, Radiology and Laboratory department staff. Research team and patients would also be stakeholders as they are directly or indirectly involved in the study. 7. Ethical issue The data will be collected from the EMS Registration Records, and all information arising from it will be treated with confidentiality. Identity of any patient will not be revealed and the results obtained will be used only for research and scientific purposes. I will apply for ethics approval from University Ethics Committee.  8. Research Evaluation Large data that is relevant would be taken from the registration log book so that it could lead to productive analysis and recommendations. Reliability and validity of data would be tested through trial data analysis which would serve as key process evaluation tool. Quantitative as well as qualitative data would be used. The outcome evaluation will be the measure of how well have the outcome objectives been achieved within time frames. 9. Risk Assessment Some of the risks which may be involved in this study are:  • Lack of responses from the EMS leaders in KFSH, I will send the permission request to the offices of EMS Chairman.  • Lack of EMS registration records data.  • Systems shut down.  • Changing management of the hospital or EMS  • Changing my supervisor or sponsors policy.  • Lack of cooperation from the senior management of EMS of KFSH in implementing the recommendations made after the study. If any such unfortunate situation arises, only solution could be the negotiation between the management with strong evidence of improvement if the recommendations are implemented.  10. Conclusion Within the emergency department in King Faisal Specialist Hospital the key areas where innovations are needed would be suggested to reduce waits. Theoretical evidences suggest myriad ways to reduce wait list. The introduction of near-patient testing and fast track systems for minor injuries are important mechanisms that expedite patient care systems of diverting people away from emergency departments (for example triage out, co-payment) could be effective but their safety is as yet unproven. Evidence also suggests that other areas such as the use of nurse practitioners, more senior medical staff, and IT solutions might be effective as well. Introducing social services in the emergency department in King Faisal Specialist Hospital is yet another new approach that can potentially decrease the number of return visits to the emergency department as well as improve the quality of care. Further research should cover cultural attitudes and changes in emergency departments, which affect waits and attendances.  Reference Bond, P.A. ‘A staffed ED assessment room: impact on wait times for non-urgent patients at a Saudi Arabian hospital’. Journal of Emergency Nursing, 27 (2001): 394-395.  Cooke, M.W. and Jenner, T. Public Attitudes and Perceptions of Accident and Emergency: Internal Report. London: Department of Health. 2002. Derlet, R.W. and Richards, J.R. ‘Overcrowding in the nation’s emergency departments: complex causes and disturbing effects’. Annals of Emergency Medicine, 35 (2000): 63-68. Pearce, L. ‘Complete turnaround: Tears, long trolley waits and a hostile local press characterised A&E in Bath’. Nursing Standard, 16 (2002): 16-17. Stirling, G., Higgins, J. and Cooke, M.W. ‘Violence in A&E departments: A systematic review of the literature’, Accident and Emergency Nursing, 9 (2001): 77-85. Trout, A., Magnusson, A.R. and Hedges, J. R. ‘Patient satisfaction investigations and the emergency department’. Academic Emergency Medicine, 7 (2000): 695-709.  Witt, D.J. ‘Transcription services in the ED’. American Journal of Emergency Medicine, 13 (1995): 34-36.  Read More