Improving the wait time to admission by reducing bed rejections.

Area of Science:

• Healthcare Management
• Quality Improvement Science
• Hospital Operations

Background:

• Emergency department (ED) congestion leads to increased patient wait times, morbidity, and mortality.
• Prolonged wait times for admission are a significant contributor to ED congestion.
• Bed rejections by ward staff for allocated beds by the Bed Management Unit (BMU) are a primary cause of prolonged admission wait times.

Purpose of the Study:

• To reduce the incidence of bed rejections by 50% (from 9% to 4.5%) within six months.
• To decrease overall patient wait times for admission to the hospital.
• To improve the efficiency and ownership of the hospital admissions process.

Main Methods:

• Utilized Plan-Do-Study-Act (PDSA) cycles for iterative quality improvement.
• Implemented interventions including updating ward categorisation, a 'no rejects' policy, and ward-level audits.
• Focused on addressing systemic issues contributing to bed rejections.

Main Results:

• Reduced rejected BMU allocation requests from 9% to 5% (p<0.01).
• Decreased the monthly percentage of patients with at least one rejection from 7% to 4% (p<0.01).
• Reduced average wait time for final ward acknowledgement from 2h 19min to 1h (p<0.01), decreasing overall admission wait time by 68 min (from 5h 13min to 4h 5min).

Conclusions:

• The quality improvement initiative successfully reduced bed rejections and significantly decreased patient wait times for admission.
• Improvements in wait times were sustained hospital-wide, benefiting all admission sources.
• The effort fostered increased ownership of the admissions process among nursing and BMU staff.