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Title: Exploring the factors that influence patient flow in an emergency department
Author: De Freitas, Loren
ISNI:       0000 0004 7964 5353
Awarding Body: University of Sheffield
Current Institution: University of Sheffield
Date of Award: 2019
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Introduction: Patient flow is a complex element of emergency departments that affects the efficiency and quality of care. Improving ED patient flow requires an understanding of how ED processes work. An exploration of value and waste in the ED patient flow process may also contribute to an understanding of patient flow. This project seeks to identify the factors that influence patient flow and explore the concepts of value and waste in the process. Methods: Multiple qualitative methods were used to explore the ED patient flow process in a single case study site. Two literature reviews - an umbrella review of interventions to improve patient flow and a qualitative synthesis on determinants of patient flow - informed the study approach. Non-participant observations (48 hours), observational process mapping (155 hours) and informal conversational interviews were used to collect data. A thematic synthesis of the findings was undertaken. Findings: The primary study findings identified seven themes on factors influencing ED patient flow- ED organizational work processes, ED design, layout, use of space, material resources, ED nursing staff levels, ED nursing roles and skill use, ED non-clinical staff and external clinical and non-clinical departments. Valuable steps in the patient process were those the improved the patient's health or experience and those that led to an exchange of information or knowledge. Wasteful steps were those that delayed patient progression, led to no exchange of knowledge or information and led to a perceived inappropriate use of the ED or doctors' time. Conclusion: This study has provided deeper insights and explanation into the factors influencing emergency department patient flow and has explored the concepts of value and waste in the patient flow process. Two conceptual models have been developed and practical examples used to illustrate the use of the models in emergency departments.
Supervisor: Goodacre, Steve ; O'Hara, Rachel ; Thokala, Praveen Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available