INTRODUCTION: To identify areas of opportunity and gaps and develop and test strategies to improve patient treatment in the observation units of two regional community medical centers. METHODS: The Plan-Do-Study-Act (PDSA) approach identified the two common emergency department complaints (syncope and collapse; unspecified atrial fibrillation) with the longest patient length of stay (LOS) in observation. Fishbone exercises elucidated these gaps. Departmental meetings, group discussions, and 1:1 discussion of particular cases provided education to reduce LOS. RESULTS: Plan-Do-Study-Act target goal for median LOS for these two complaints was 30 hours, which was approximately 12% less than the median LOS during the data collection stage. The PDSA process improved care efficiency, as demonstrated by reduced LOS for the atrial fibrillation cohort between the early and later months after launch and implementation. For the syncope cohort, the median LOS met or remained below the target threshold of 30 hours from the mid-point through the later stages of the implementation period. CONCLUSIONS: The reproducible PDSA-improved processes lowered the median LOS of patients with syncope or atrial fibrillation in observation status to the target goal of 30 hours or less in the past 5 and 8 months, respectively, of the launch and implementation stages.
Xavier et al. (Mon,) studied this question.