Quality Improvement Interventions to Reduce the Emergency Department Length of Stay (EDLOS) in the Green Zone- a Mixed Method Study

Introduction: Emergency Department Length of Stay (EDLOS) is a critical indicator of overcrowding, which has become a significant public health concern worldwide. Overcrowding reduces the quality of care, increases the risk of medical errors, causes dissatisfaction among patients, and causes burnout in healthcare workers. There is limited literature on implementing and evaluating solutions to prolong EDLOS. This study aims to assess the impact of quality improvement initiatives for reducing the length of stay in the Green Zone of the Emergency Department of a tertiary-level hospital and their effect on patient satisfaction. The objectives were to explore the health-related issues and challenges encountered by patients in green zones, to develop feasible interventions to address these problems, and to assess the effectiveness of quality improvement interventions in reducing EDLOS. Methods: This was an exploratory mixed-method study design with purposive sampling. A multidisciplinary quality improvement (QI) team was formed, and process flow diagrams and fishbone analysis were used to identify factors contributing to prolonged triage waiting time. Orientation sessions empowered staff, and patient experiences were explored through interviews. Change ideas were tested iteratively, focusing on feasible interventions to reduce waiting time. The successes and challenges of each change attempt were documented, focusing on lowering consultation delays as a primary factor contributing to prolonged EDLOS. Results: There was a significant decrease in median EDLOS from 170 to 149 min (p 0.038) after intervention. The median number of patients who stayed for more than 120 min, 360 min, and 600 min was decreased from 415 (IQR 391- 478) to 362 (IQR 322-374) (p 0.011), 144 (IQR 104-164) to 91(IQR 82-119) (p 0.066), and 65 (IQR 37-67) to 26 (IQR 22-33) (p 0.066), respectively. Conclusion: This quality improvement study effectively reduced patient stay duration in the ED through targeted interventions, improving workflow and efficiency.