Emergency Room Wait Time: Literature Review

Khankeh’s Study

Citation

Khankeh, H., Khorasani-Zavareh, D., Azizi-Naghdloo, F., & Hoseini, M. (2013). Triage effect on the wait time of receiving treatment services and patients satisfaction in the emergency department: Example from Iran. Iranian Journal of Nursing and Midwifery, 18(1), 79-83.

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Type of Study, Design Type, Framework/Theory

Type of Study: quantitative research.

Design Type: quasi-experimental study (Houde, 2009).

Framework/Theory: case group vs. control group.

Setting

Shahid Rajaee hospital.

Concepts/Variables

  • Concepts: evaluating the effect of triage.
  • Independent Variable: the human factor.
  • Dependent Variable: wait time, patient satisfaction.
  • Controlled Variable: triage.

Findings

The study conducted by Khankeh, Khorasani-Zavareh, Azizi-Naghdloo, & Hoseini (2013) discussed the probability of making a difference in patient satisfaction using triage. They identified a control group and then assembled the case group to conduct their quasi-experimental study. The researchers claimed that the existing studies in the area did not link triage to the concept of patient satisfaction (Khankeh et al., 2013).

They also observed the emergency department in terms of the wait time and patient rotation. Khankeh et al. (2013) were able to conclude that nurse education and triage system were the key contributors to the decrease in negative healthcare facility factors. The outcomes of the study hinted at the fact that there is a necessity to introduce a training program and reassess the value of nursing skills within the healthcare environment.

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Hierarchy of Evidence Level

Necessary elements are described in detail.

Iacobucci’s Study

Citation

Iacobucci, G. (2015). Patient flow issues caused longer A&E waits last winter, Monitor says. BMJ, 351, 4780.

Type of Study, Design Type, Framework/Theory

  • Type of Study: detailed data analysis.
  • Design Type: qualitative.
  • Framework/Theory: Analysis of the healthcare system (Houde, 2009).

Setting

Emergency department in England.

Concepts/Variables

  • Concepts: accident and emergency department are seriously contingent on external factors.
  • Independent Variable: patient stay time.
  • Dependent Variable: number of beds.
  • Controlled Variable: accident and emergency.

Findings

The key issue that was discussed by the author of the article is that patients are exposed to enlengthened periods of wait in the accident and emergency environment (Iacobucci, 2015). Ultimately this led to delays in the patient rotation and increased the transfer rate (to community care) of patients by 27%. The effect of this event, nonetheless, was not considered a sufficient body of evidence. Moreover, there was no evidence regarding the patients that went to the accident and emergency department in vain. The findings presented by Iacobucci (2015) also reflected the idea that the results of this review are inconsistent, and none of the variables can be predicted. The researcher found no evidence regarding the complexity of staffing issues and the number of beds that were available to the department. The challenges were not addressed sufficiently.

Hierarchy of Evidence Level

Insufficient evidence.

Handley’s Study

Citation

Handley, A. (2011). Fast-track to efficiency. Nursing Standard, 25(20), 18-19.

Type of Study, Design Type, Framework/Theory

  • Type of Study: research article.
  • Design Type: qualitative meta-analysis.
  • Framework/Theory: the role of the nurse in emergency conditions.

Setting

Midlands hospital.

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Concepts/Variables

  • Concepts: the impact of the reduction of waiting times on the functioning of emergency department.
  • Independent Variable: patient rotation time.
  • Dependent Variable: patient satisfaction.
  • Controlled Variable: wait time.

Findings

The evidence presented by Handley (2011) suggests that the new nursing role within the emergency environment can be implemented in the majority of the hospitals that adhere to the same model of functioning. The idea behind that was that the role would become an essential part of nursing practice at the hospital (Handley, 2011). It was found that even nurses themselves felt good about their new role and assessed the patient way better than before. The nurses’ decision-making methodology also improved as they were exposed to more freedom in terms of their hospital activity. The outcomes showed that the patients’ waiting time went from 120 minutes to only ten minutes, and the assessment did not lose in quality or inclusiveness (Handley, 2011). The findings of the study can be perceived as the ultimate body of evidence that supports the idea of implementing a new nursing role that will help to minimize patients’ waiting times.

Hierarchy of Evidence Level

The findings are relevant.

Sayah’s Study

Citation

Sayah, A., Rogers, L., Devarajan, K., Kingsley-Rocker, L., & Lobon, L. F. (2014). Minimizing ED waiting times and improving patient flow and experience of care. Emergency Medicine International, 2014(2), 1-8.

Type of Study, Design Type, Framework/Theory

  • Type of Study: research article (Houde, 2009).
  • Design Type: pre- and postintervention analysis.
  • Framework/Theory: system-wide process improvement.

Setting

Academic public institution.

Concepts/Variables

  • Concepts: reduced waiting time affects patient outcomes positively.
  • Independent Variable: the experience of care.
  • Dependent Variable: patient flow, ambulance diversion.
  • Controlled Variable: ED waiting time.

Findings

The research that was conducted by Sayah, Rogers, Devarajan, Kingsley-Rocker, and Lobon (2014) dwells on the analysis of the influence of ED on the hospital improvements. The authors of the study found that all the metrics were significantly influenced by the changes that were made in the ED. Ambulance diversion critically went down, and this resulted in the reduction of the ED time (from 204 minutes to 132) (Sayah et al., 2014).

It is critical to mention that the authors of the study found that the level of patient satisfaction also increased together with the patient volume. The indicator connected to the quality measures also went up, and the number of the patients that left before being examined went down from 4% to 1% (Sayah et al., 2014). The overall efficiency of the healthcare facility was found to improve.

Hierarchy of Evidence Level

Adequate evidence.

Nelson’s Study

Citation

Nelson, C., & Kesling, B. (2014). Allegations over VA wait times spur rising unease among democrats. Wall Street Journal.

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Type of Study, Design Type, Framework/Theory

Type of Study: news article.

Design Type: qualitative analysis.

Setting

Department of Veterans Affairs health facility (VA).

Concepts/Variables

  • Concepts: excessive wait time led to the death of several people.
  • Dependent Variable: patient well-being and satisfaction.
  • Controlled Variable: wait time.

Findings

Nelson and Kesling (2014) found that wait times were not the main reason for the death of several veterans in Virginia. Nonetheless, no evidence would support that supposition, and no one in the government ever fully addressed that issue (Nelson and Kesling, 2014). The existing body of evidence suggests that the policy-makers should revise the current wait time legislation, but this decision is way far from the final for now.

Hierarchy of Evidence Level

Insufficient evidence.

Conclusion

The current state of knowledge is relatively supported by the synthesized body of evidence presented in this paper. There are conclusions regarding the importance of reducing waiting time to enhance the quality of health care. All the sources indicate that this parameter is crucial for the emergency department as a prolonged waiting time may lead to grave symptoms or even death. One of the most evident inconsistencies can be found in Nelson and Kesling’s (2014) research article as they do not disclose any adequate proof of how waiting time influenced the increased occurrence of death among seniors and simply list some allegations that may or may not be true. Based on the synthesized literature, a verdict can be reached that further research is necessary because there is not enough quantitative data that can refute the thesis that waiting times influence the quality of care and may lead to dreadful consequences.

Reference

Houde, S. C. (2009). The systematic review of the literature. Journal of Gerontological Nursing, 35(9), 9-12. Web.

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StudyCorgi. (2020) 'Emergency Room Wait Time: Literature Review'. 3 December.

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