Internal medicine consults within the emergency department: A workflow intervention to match workforce with workload
1 Department of Medicine, Queen’s University, Kingston, Ontario, Canada.
2 Department of Psychology, Queen’s University, Kingston, Ontario, Canada.
Research Article
World Journal of Biology Pharmacy and Health Sciences, 2024, 18(01), 368–375.
Article DOI: 10.30574/wjbphs.2024.18.1.0217
Publication history:
Received on 10 March 2024; revised on 22 April 2024; accepted on 25 April 2024
Abstract:
Background. Emergency departments (ED) are increasingly overcrowded, exacerbated by patients awaiting consultations and inpatient beds. Internal Medicine (IM) is the most consulted specialty service from the ED. Patients experience long delays after being consulted to Internal Medicine (IM).
Objective. Decrease these delays by improving the IM consult process.
Methods. A three stage process was designed. First: Analysis of the IM consult workflow over a 27-day period to identify the longest delays. Then implement a data-driven intervention. Second: Quantitatively assess the intervention by comparing three-month periods Pre-Intervention (Time A) with Post-Intervention (Time B). Third: Qualitatively assess the intervention by surveying residents.
Results. The first stage included 398 consults. The longest delays were awaiting bed availability post admission order completion (mean 19.5 hours) and awaiting the initial junior resident assessment (mean 3.6 hours). This assessment delay significantly increased during busy shifts. The intervention involved the addition of an extra IM resident during the busiest four hours of the day. The second stage compared 1162 patients from Time A with 1263 patients from Time B. There was no significant change in assessment times post-intervention. However, there was an 8% increase in consult volume in Time B as compared to Time A. The third stage captured 100% of the 23 senior residents. Overall, residents reported the change as beneficial to themselves and the patients.
Conclusions. For patients consulted to IM in the ED, inpatient bed availability contributed to the largest delay to leave the ED. Increasing IM resident staffing during peak hours did not decrease time to complete consults. However, increased IM resident staffing was perceived as beneficial to both residents and patients.
Keywords:
Emergency Medicine; Internal Medicine; Workflow; Medical Education
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Copyright © 2024 Author(s) retain the copyright of this article. This article is published under the terms of the Creative Commons Attribution Liscense 4.0