Abstract

Aims: To create a system to co-ordinate the medical take, bed management and track patient flow.
To use the system to continuously audit against Society for Acute Medicine Quality Indicators.
To use the data to model patient flow and optimize working patterns to improve waiting times.

Method: An online whiteboard and underlying database system were designed, tested and implemented.
Data from this system were used to audit against SAM Quality Indicators and then analysed to optimise both trainee and consultant working patterns.

Results: The online whiteboard proved effective and popular as a working tool.
Data collection improved using the electronic system.
Optimising junior doctor working patterns to match demand led to a reduction of average waiting time to see a doctor from 190 minutes to 71 minutes (p < 0.0001), and a reduction in the proportion of patients waiting over 4 hours from 40% to 10% (p < 0.0001).
Optimising consultant working patterns did not produced significant changes in waiting times.

Conclusions: The online whiteboard improved day-to-day working and data collection, when compared to the previous paper-based system.
Better data facilitated analysis of working patterns leading to a significant improvement in patient waiting times.

[download-attachments container="div" style="list" display_icon="1" display_count="1" display__size="0"]

References

1. Capewell S. The continuing rise in emergency admissions. BMJ 1996; 312: 991–2.
2. Kendrick S, Conway M. Increasing Emergency Hospital Admissions among Older People in Scotland: A Whole System Account. Edinburgh: Information and Statistics Division, 2003.
3. Acute medical units: review of evidence. Eur J Intern Med. 2011 Aug; 22(4): 344–7.
4. Guttman et al. Association between waiting times and short term mortality and hospital admission after departure from emergency BMJ 2011; 342: d2983.
5. Rivers E, Nguyen B, Havstad S, et al. Early goal directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001;345: 1368–77.
6. National Institute for Health and Clinical Excellence. Chest pain of recent onset. Assessment and diagnosis of recent onset chest pain or discomfort
   of suspected cardiac orgin. London: NICE, 2010.
7. Wardlaw JM, Murray V, Berge E, et al. Thrombolysis in ischaemic stroke. Stroke 2004; 35: 2914–5.
8. Society for Acute Medicine. Clinical Quality Indicators for Acute Medical Units (AMUs). June 2012.
9. Bell D, Lambourne A, Percival F, et al. Ward DK (2013) Consultant Input in Acute Medical Admissions and Patient Outcomes in Hospitals in England: A Multivariate Analysis. PLoS ONE 8(4):e61476. doi:10.1371/journal.pone.0061476https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0061476
10. Royal College of Physicians. An evaluation of consultant input into acute medical admissions management in England. Report of hospital service patterns versus clinical outcomes in England. London:RCP, 2012.
11. Safety in numbers: lack of evidence to indicate the number of physicians needed to provide safe acute medical care Clin Med October 1, 2014; 14: 462–46.
12. Le Jeune I, Masterton-Smith C, Subbe CP, et al. State of the Nation – The Society for Acute Medicine’s Benchmarking Audit 2013 (SAMBA ‘13). Acute Medicine 2013; 12: 214–219.
13. Subbe CP, Burford C, Le Jeune I et al. Clin Med 2015; 15:15–19.
14. Subbe CP, Le Jeune I, Burford C, et al. The Team at Work –The Society for Acute Medicine’s Benchmarking Audit 2014 (SAMBA ‘14). Acute Medicine 2014; 14: 99–103.
15. Sabin J, Subbe CP, Vaughan L, et al. Clin Med 2015; 14:462–467