Developing a programme of patient 'streaming' in an emergency department

Area of Science:

• Orthopaedic Surgery
• Emergency Medicine
• Healthcare Management

Background:

• Orthopaedic and musculoskeletal injuries are frequent presentations in emergency departments (EDs).
• Current ED triage systems may cause delays for patients with conditions like Colles fractures.
• Timely assessment and transition are crucial for effective patient care, especially for elderly patients.

Purpose of the Study:

• To explore the impact of 'streaming' patients with musculoskeletal problems in an ED.
• To evaluate improvements in waiting and treatment times through patient streaming.
• To highlight the prevalence of musculoskeletal issues in ED attendees.

Main Methods:

• Analysis of audit data collected over four years.
• Implementation and assessment of a 'streaming' patient pathway in a local ED.
• Comparison of waiting and treatment times before and after implementing the streaming system.

Main Results:

• Patient streaming demonstrated clear benefits in reducing waiting and treatment times.
• Musculoskeletal problems accounted for a significant proportion of ED attendances (e.g., 1 in 3 in December 2012).
• The 'streaming' model facilitated a smoother transition of care for orthopaedic patients.

Conclusions:

• 'Streaming' patients in the ED is an effective strategy for improving efficiency in managing orthopaedic and musculoskeletal injuries.
• This approach can help meet targets for timely surgical intervention, such as the 48-hour target for hip fractures.
• Optimizing patient flow in EDs is essential for addressing the high volume of musculoskeletal presentations.