Enhancing Emergency Department Efficiency: A Quality Improvement Initiative to Optimize Patient Flow and Critical Care Utilization

Introduction: Efficient patient flow in emergency departments (EDs) is vital for improving outcomes, particularly for critically ill patients. Despite expanding critical care capacity, inefficiencies in processing times, bed allocation, and patient transfers were observed in the Regional Emergency Medical Center (REMC). This study aimed to evaluate the impact of quality improvement (QI) interventions on optimizing decision-to-discharge and discharge-to-exit times while enhancing critical care utilization. Methods: A multi-faceted QI initiative was conducted to streamline patient flow and optimize resource utilization from January to August 2024. The study period was divided into two phases: pre-intervention (January to April) and post-intervention (May to August). Key strategies included educational sessions to enhance staff competencies, the introduction of a “Zone Movement Assessment Tool” to improve patient transfers, and bed allocation based on the Korean Triage and Acuity Scale (KTAS), as well as collaboration with administrative units and local fire departments to expedite admissions. Data on decision-to-discharge and discharge-to-exit times were collected before and after these interventions, alongside metrics on bed utilization rates and financial impact. Results: The interventions reduced the median decision-to-discharge time from 147 to 130.5 minutes and discharge-to-exit time from 80.25 to 55 minutes. Although not statistically significant (p > 0.05), boxplot analysis showed decreased variability, improving consistency. A strong correlation (r = 0.91) between the two metrics suggested that improvements in one area positively impacted the other. KTAS Level 3 patient allocation increased from 55% to 82%, and bed turnover nearly doubled from 2.9 to 4.8 times per month. Critical care revenue increased by KRW 302,826,630. Conclusion: The QI initiative improved ED efficiency, enhancing patient flow and resource utilization. While not statistically significant, the gains in consistency, bed use, and revenue highlight practical benefits. Ongoing monitoring, staff training, and iterative improvements are recommended to sustain these outcomes. Further studies with larger samples are needed to validate these results.