Measured Time and Perceived Time: Crucial Data in Reducing and Managing the Time Spent at the Emergency Department

Document Type: Original Article

Authors

1 Sunway Medical Centre,Malaysia.

2 Consultant Emergency Physician and Head of A&E,Malaysia.

Abstract

Introduction:Wait time at the emergency department is a global issue. However, most studies have relied on measured times to reduce and manage wait times at the emergency department. 
Material and Methods: A quality improvement project using a mixed-method was conducted to reduce and manage the time patients spent at the emergency department. 
Results: In-depth interviews with the business team staff showed that pharmacy was perceived by them as taking 30 minutes to complete the medication orders. Pharmacy was therefore seen as the bottleneck within the patient flow at the emergency department by these staff. However, when the times pharmacy completed the orders were measured using time stamps, the measured times were found to be 10 minutes. The business team staff found the measured time data as failing to capture their interactions with pharmacy. Hence, observations were further conducted with the business team staff to understand their perceptions. These observations found that patients were constantly approaching the business team staff for updates on their pharmacy orders which added anxiety to the business team staff. The led them to continuously check the hospital information system for any updates on the completions of the pharmacy orders as this was needed to finalize the bills and discharge the patients from the emergency departments. These anxiety and workload led to the perceived time to be 30 minutes among the staff. 
Conclusion: The combinations of perceived time and measured time data were used in this quality improvement project to advocate to the nurses and emergency department physicians to inform the patients that pharmacy would take time to thoroughly check and complete the orders and that they would be called to the counter by the business team staff when the orders were completed. This helped to manage the expectations of the patients and reduce the anxiety and workload of the staff. 

Keywords


1- Trzeciak S, Rivers EP. Emergency department overcrowding in the United States: an emerging threat to patient safety and public health. Emerg Med J. 2003; 20(5):402-5.  
2- Wellstood K, Wilson K, Eyles J. “Unless you went in with your head under your arm”:patient perceptions of emergency room visits. Soc Sci Med. 2005; 61(11):2363-73.  
3- Johnson M, Myers S, Wineholt J, Pollack M,Kusmiesz AL. Patients who leave the emergency department without being seen. J Emerg Nurs. 2009; 35(2): 105-8. 
4- Donnelly L. Man dies due to A&E overcrowding, says hospital trust's medical director. The Telegraph. Available at: URL: https://www.telegraph.co.uk/news/2018/03/09/man-dies-due-ae-overcrowding-says-hospital-trusts-medical-director/; 2018.  
5- Authier P. Quebec has worst emergency room wait times, health and welcome commissioner say. Montreal Gazette. Available at: URL: http://montrealgazette.com/news/quebec/quebec-has-worst-emergencyroom-wait-times-health-and-welfare-commissioner-says;2016.
6- Roeckelein JE. The concept of time in psychology: a resource book and annotated bibliography. Connecticut, USA: Greenwood Publishing Group; 2000. 
7- Khalifa M, Khalid P. Developing strategic health care key performance indicators: a case study on a tertiary care hospital. Proc Comput Sci. 2015; 63:459-66.  
8- Brabrand M, Folkestad L, Hosbond S.Perception of time by professional health care workers during simulated cardiac arrest. Am J Emerg Med. 2011; 29(1):124-6.  
9- Kelly C, Shulman V, Khine H, Avner JR. Parental perception of the passage of time during a stressful event. Pediatr Emerg Care. 2007; 23(6):376-9. 
10- Saunders B, Sim J, Kingstone T, Baker S,Waterfield J, Bartlam B, et al. Saturation in qualitative research: exploring its conceptualization and operationalization.Qual Quant. 2018; 52(4):1893-907. 
11- Ferreira VF, Paiva GP, Prando N, Graça CR,Kouyoumdjian JA. Time perception and age. Arq Neuro Psiquiatr. 2016; 74(4):299-302.
12- Vasile C. Time perception, cognitive correlates, age and emotions. Proc Soc Behav Sci. 2015; 187:695-9.