The study of waiting lines at the Mater Dei emergency department

Abstract

Waiting time is a global phenomenon that can never be completely removed from a service and this affects all types of organizations around the world. The Mater Dei Emergency department is no exception to this phenomenon and has been receiving various complaints throughout the years from patients having to wait a long period of time before receiving treatment or consultation. The fact that the public healthcare system in Malta is free results in creating a higher demand than the supply that can be offered. Decreasing this waiting time is considered to be imperative since it can reduce patient morbidity and mortality. The collection of this data was provided through the personal records kept at the Mater Dei Emergency Department over a 10 day sample period. The relationship between the total waiting time of patients and the (i) length of stay (LOS) from registration to first significant medical encounter (FSME), (ii) patient’s ESI level, (iii) volume of patients per day and (iv) registration time of patients, were analysed in turn using correlation coefficients. This study revealed that the main variable affecting the total LOS was the time taken for the FSME to be performed. There was also a moderate negative relationship between the total LOS and the patient’s ESI level, meaning that the higher the ESI level the shorter resulting patient’s LOS. The time when a patient enters the Emergency department was also found to have a small relationship to the total LOS, since the LOS is likely to take longer during evening hours when compared to the morning hours. It was also found that there was no relationship between the LOS and volume of patients per day. Therefore being able to offer timely critical care, to those in need, is vital for the patient’s wellbeing. The important recommendations, which could help the emergency department, to improve the total LOS for patients are also outlined in this study. These recommendations included the investment in personnel within the emergency department in order to have the right amount of human resources levels to meet patients demand and by having a coordinated team work between the medical staff, especially doctors and nurses as well as the creation of a ‘fast track’ for patients. It was also recommended to give nurses additional responsibilities in order to be able to take decisions related to minor injuries and to have the authority to request tests for patients prior to being seen by a doctor. The final recommendation is to create a Hospital Length of Stay Committee to be able to create a wide flow of policies and processes throughout the whole hospital, by helping and improving the length of stay for patients.