A Statistical Methodology to determine factors affecting Patient Experience Time Targets in the Emergency Department.

 

Sir,

The Emergency Medicine Programme in Ireland recommends a national Total ED Time standard of 95% of patients having their emergency care completed within 6 hours of arrival in an Emergency Department (ED)1. It is known that prolonged durations of stay in Emergency Departments are associated with poorer patient outcomes2,3. Numerous factors influence Patient Experience Time (PET) targets . We conducted a pilot study in Connolly Hospital ED over a month’s period utilising Regression analysis method to determine factors within the ED that had maximum influence on Patient Experience Time (PET) targets.

Eleven variables were selected from the ED on the knowledge of our senior physician that were felt to influence Patient Experience Times and recorded for each day of May 2015. They included the following: TBS8AM-Number of patients waiting to be seen by an ED physician at 8am each day, TBS8PM-Number of patients waiting to be seen by an ED physician at 8pm each day, NEWATT-Total number of  new ED attendances over 24 hours, ADM8AM-Number of boarded inpatients in ED at 8am each day, ADM8PM- Number of boarded inpatients in ED at 8pm each day, SHOHRS-Total  number of  ED Senior House Officer  working hours  per 24 hours, REGHRS-Total number of  ED Registrar working hours per 24 hours, ANP-Total  number of Advanced Nurse Practitioner working hours per 24 hours, CNS-Total  number of Clinical Nurse Specialist working hours per 24 hours, PET6NA-Percentage of non-admitted patients compliant with a Patient Experience Time <6 hours over a 24 hour period, PET9NA-Percentage of non-admitted patients compliant with a Patient Experience Time <9 hours over a 24 hour period. A Regression analysis method was applied using the software IBM SPSS to analyse variables that had maximum influence on the PET6NA and the PET9NA.

The statistical analysis concluded that of all the independent variables affecting PET6NA, TBS8PM held maximum significance (p<0.01). Pearson’s correlation showed that the less patients waiting to be seen by an ED physician at 8pm, the higher the percentage compliance for meeting the ‘6-hour target’ for non-admitted patients over a 24 hour period (r = -0.601). Secondly, the analysis concluded that of all the independent variables affecting PET9NA, TBS8AM held maximum significance (p<0.05). Pearson’s correlation showed that the less patients waiting to be seen by an ED physician at 8am ,the higher the percentage compliance for  meeting the ‘9-hour target’ for non-admitted patients over a 24 hour period ( r = -0.227). An additional finding was that, the greater the number of ED Registrar working hours per day, the higher the percentage compliance for meeting the ‘9-hour target’ for non-admitted patients over a 24 hour period (p<0.05, r = +0.186).    

This is a pilot study that draws a correlation between existing variables of an Irish Emergency Department and how they affect Patient Experience Times. Our results were limited to a single month of May 2015. Using different variables, this model has a potential to be introduced at national level. Data collection and analysis has the power to improve the standard of patient’s experience and overall ED performance.

F Borhan, S Ahmed,  L Varghese, E O’Conor.

Department of Emergency Medicine, Connolly Hospital , Blanchardstown, Dublin 15, Ireland.

Correspondence: Dr. Fareeda Borhan, Emergency Department, Connolly Hospital, Blanchardstown, Dublin 15, Ireland.

Email: fareedaborhan@yahoo.com

References

1.The National Emergency Medicine Programme  Report , June 2012.

2.Sprivulis PC, Da Silva J-A, Jacobs IG, Frazer ARL, Jelinek GA. The Association between hospital overcrowding and mortality among patients admitted via Western Australian Emergency Departments. Med J Aust. 2006; 184:208–212.

3.Richardson DB.The access-block effect: relationship between delay  to reaching an in-patient bed and in-patient length of stay. Med J Aust. 2002; 177(9):492-495