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Quality Improvement

IDEAS Team Publishes their Quality Improvement Project

Doctors and nurses surrounding an emergency room patient

A quality improvement project undertaken by IDEAS’ Cohort 6 has been published in BMJ Quality Improvement Reports. This project focused on the emergency department (ED) of Toronto Western Hospital. At this ED, steadily rising patient volumes were resulting in congestion in the ED waiting room, where medically undifferentiated and potentially unstable patients must wait until a bed becomes available. The aim was to reduce the 90th percentile of wait time between triage and bed assignment from 120 to 60 minutes for high-acuity patients.

Working with key stakeholders, the IDEAS team identified multiple flow-interrupting challenges, including operational bottlenecks and cultural issues. The team then generated change ideas to address unnecessary patient use of ED beds and communication breakdown causing delays in bed turnaround. Seven tests of change were performed through sequential plan-do-study-act cycles. The most significant gains were made by improving communication: small gains were made by optimizing in-house digital information management systems, while larger improvements were achieved with a low-tech direct contact mechanism (two-way radio or walkie-talkie). In the post-intervention phase, time-to-bed for the 90th percentile of high-acuity patients decreased from 120 minutes to 66 minutes, with special cause variation showing a significant shift in weekly measurements. For more information, please contact the project lead, Dr. Lucas Chartier.

Applications for IDEAS Cohort 11 are now being accepted. Click here for more information.


Source: Chartier LB, Simoes L, Kuipers M, McGovern B. Improving Emergency Department flow through optimized bed utilization. BMJ Qual Improv Report. 2016;5:(1).

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