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08/03/15
Working as both an Emergency Medicine Consultant and a Management Consultant means I visit many Emergency Departments around the world. One thing has become clear to me, irrespective of whether the Emergency Department is in the United Kingdom, Scandinavia, North America or the Middle East; we are all trying to solve the same problem. Overcrowding.
 
Overcrowding is caused by many factors intrinsic and extrinsic to the Emergency Department. Patients suffer in crowded Emergency Departments as it is associated with poor patient experience, low staff morale and increased mortality and morbidity.
 


It is easy to for us embedded on the frontline to look at problems external to our service as the sole cause of our woes, and it is true that external factors do influence patient flow, but there are many things that we can do in the Emergency Department to reduce overcrowding whilst problems are being resolved elsewhere in the system.
 
The key to reducing overcrowding is shortening patient journey times. The shorter the patient journey times, the fewer the number of patients in the department at any one point in time. Time saved at the beginning of the patient journey has a greater impact on the overall total journey time than time saved at the end. This works in a similar way to compound interest on a bank account. Compound interest is interest added to the initial sum of money so that the added interest also earns interest from then on. Similarly, time saved early in a process leads to an amplification of this time-saving throughout the process.
 
Using this principle, we undertook an experiment using a consultant-led rapid assessment model and performed investigations as soon as the patient arrived. In addition, we introduced Point of Care Testing into the initial assessment process as a means of introducing considerable time-saving early in the process.
 
We showed that utilising rapid diagnostics at the front door of the Emergency Department reduces patient journey times by approximately 40%. This reduces the number of patients undergoing care in the Emergency Department at any one time by approximately 45%.
 
Consultant-led rapid assessment utilising Point of Care Testing significantly reduces the number of patients waiting and helps to reduce overcrowding. However, running a Consultant-led rapid assessment model is labour intensive and for it to be successful the balance between capacity and demand has to be struck. Prior to embarking on this working pattern it is imperative that nursing numbers and the work content are calculated, otherwise it leads to burn out and queuing. 
By Dr Paul Jarvis