Waiting and interaction times for patients in a developing country accident and emergency department

To determine the interaction and waiting times of patients in Barbados Queen Elizabeth Hospital Accident and Emergency Department (A&E), identify their determinants, and compare them to international benchmarks.

Trained research assistants monitored all patients attending A&E during a one week period in 2003. The time in and out of each step in the process of care was recorded along with demographic data, diagnosis, and acuity. Time elapsed was calculated for various steps in care and compared to international benchmarks. Determinants of timely care were identified.

Of 882 eligible A&E patients, 675 (77%) had accurate data and were entered into the study. Interaction times were short, with median total interaction time 13 (IQR 9-21) minutes. Waiting times were long ranging from median 6.5 (IQR 2-22) minutes for registration to 213 (IQR 154-316) minutes for lab results. Of concern was a median wait of 10 (IQR 2-46) minutes for triage and 178 (IQR 105-305) minutes to be seen by a doctor. Mean total length of stay was 377 (SD 261) minutes compared to US benchmark of 90 minutes. All other waiting times were at least twice US benchmarks. Paediatrics cases and children aged 0-11 years had the shortest waiting times and length of stay, whereas medicine patients and those over 49 years had the longest. Those with highest acuity had the shortest waiting times and length of stay.

The A&E could improve patient care processes by shortening waiting times, especially for laboratory results, triage, and seeing a doctor, particularly for older medicine patients.