A&E wait times slashed with digital kiosks, faster triage — QEH

Patients arriving at the Queen Elizabeth Hospital’s Accident and Emergency Department are now being registered in as little as three minutes, the hospital said Monday, with overall triage waiting times cut by 40 per cent, following sweeping efficiency reforms.

Registration, once one of the major bottlenecks, is now down to as quick as three minutes, while wait times for triage have fallen by almost half.

Service Improvement Manager Dr Ayja Clarke said on the hospital’s Pulse Radio show that new digital self-registration kiosks have made a significant difference.

“The first thing we’ve been looking at is decreasing that time to registration,” she said. “So once you get through the door of the Accident and Emergency Department, you will be screened with security. What you will see now is you are going to be directed to a digital kiosk, so a self-registration kiosk.

“So now we have decreased registration time. So once you come into the department, we have registration time sometimes as low as three minutes. Sometimes it’s ten minutes during peak times when things are really, really busy.”

Clarke said triage has also been restructured with the addition of a senior doctor working alongside nurses.

“Since introducing the changes, especially with the introduction of the physician-assisted triage, the wait times between patients coming through the door and getting to triage are down by 40 per cent,” she said.

Other measures include advanced triage, where tests and scans can be ordered earlier; nurse-initiated medication to provide pain relief on arrival; and plans for a minor case unit to fast-track patients with less severe conditions.

Head of Accident and Emergency Dr Anne Marie Cruikshank said the digital changes were also helping staff act faster.

“As [the nurses] enter digitally into the system, that information goes directly to the medical records officer. … We have physician-assisted triage, and we can now start the investigations, the pain meds, the imaging’s being ordered. Everything can start from screening or triage,” she said.

Dr Clarke also revealed that the hospital has introduced Estimated Date of Discharge boards on wards, giving teams and relatives a clear plan for getting patients home.

“Overall in the hospital, I’m happy to report that so far the average length of stay in the hospital is down in all of the wards by 1.2 days, but in the wards that we piloted the boards on, we have noted that the average length of stay is down even further, down by 2.9 days,” she said.

QEH Chief Executive Officer Neil Clark said the introduction of service improvement managers earlier this year was designed to allow departments space to rethink service delivery.

“They’ve been focused on the A&E pathway and what I call the Unplanned Care Pathway, A&E, inpatient flow and discharge planning, and we’ll move them at some point in the future to the Planned Care Pathway,” he said.

He cited oncology as one area where staff-led improvements were delivering results.

“You would have seen the cancer waiting times at 140 days for your first outpatient appointment. We’re now down to three weeks. We’re down to 21 days from 140 days. And that’s that team in the Oncology Department just taking the initiative and saying they’re going to fix this, we’re going to improve this for the population.”

Clark added: “What I sense when I walk around is that there’s a change coming. I feel that change in people who are speaking to me. I feel people are getting permission to do things. And it feels like it was always that they were waiting for the CEO to say yes you can do this and I keep saying it’s your department, if you think that works better, try it, and that’s happening.” (SM)