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Trauma Bay Time Clocks: Influence on Emergency Department Length of Stay
Jessica Hardway1, Damayanti Samanta, Kelly V Rennie
1Department of Trauma Services, Charleston Area Medical Center, Charleston, West Virginia (Dr Hardway and Ms Evans); Center for Health Services and Outcomes Research, Charleston Area Medical Center Institute for Academic Medicine, Charleston, West Virginia (Ms Samanta); and West Virginia University School of Medicine-Charleston Division, Department of Surgery, Charleston Area Medical Center, Charleston, West Virginia (Drs Rennie and Lasky).
Background:
To monitor the time elapsed since patient arrival in the emergency department, Trauma Services at the study institution installed a large digital stopwatch timer placed at the head of each trauma bay on June 5, 2017. This quality improvement endeavor became an essential component of performance evaluation.
Objective:
The purpose of the study is to measure the impact of trauma bay time clocks on emergency department length of stay.
Methods:
This is a retrospective before-and-after study of trauma activation patients between June 2015 and May 2019. Two 24-month intervals were compared before and after installation of time clocks.
Results:
In full activation patients, outcomes of emergency department length of stay ≤50 min (39.2% vs. 61.7%, p < .001) and time to transfer to intensive care unit ≤56 min (45.3% vs. 55.1%, p = .002) were significantly favorable in the postimplementation phase. Time to first computed tomography scan and time to first operating room from arrival to the emergency department were comparable between both phases. For limited activation patients, positive changes were noted in emergency department length of stay ≤87 min (41.4% vs. 60.6%, p < .001), time to first computed tomography scan ≤32 min (47.7% vs. 53.0%, p = .015), and time to transfer to intensive care unit ≤74 min (50.2% vs. 57.2%, p = .008). Time to first operating room remained comparable between two periods.
Conclusions:
The study institution improved their provision of immediate care by using time clocks in trauma bays. This is a simple and cost-effective intervention and may benefit similar institutions.
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