Exploring waiting time, waste, and resources used for boarding patients in emergency department

Abstract

Introduction: The demand for health treatment in hospitals has arisen since the Indonesian government launched the National Health Insurance. Admission delay to medical wards (MWs), which makes patients board in the emergency department (ED), disrupts patient flow. This study aims to explore the barriers to boarding patients at the ED by identifying waiting time, waste, and resource adequacy. Methods: A case study was conducted in the ED of RSUD by Dr. Moewardi. The subject was 45 patients with internal diseases. Collecting data by direct observation using a real-time method is described in value stream mapping. Problem-finding was sharpened by in-depth interviews with health workers and non-health workers in the ED and internal MWs. Results: Prominent causes of patient flow disruptions depended on service in the ED and inpatient room. Disruptions of patient flow indicated by waiting time amounted to 3 hours, 3 minutes, and 52 seconds. Patients who transferred to the transition room were considered to have gone into MWs, although patients can be treated for more than 3 days due to waiting for bed availability in the inpatient room. Waiting and motion were the most frequent. Inadequate resources both in the ED and inpatient rooms made a wide impact on patient flow, which was worsened by problems with tool layout, fragmented work, and poor utilization of the hospital information management system. Conclusion: The bottleneck in ED’s and MW's processes contributes to the degeneration of the stacked bed of boarding patients in ED. The improvements must be integrated to address the issues of waiting time, waste, and capacity. Improvements in the flow of boarding patients focus on fixing the documentation of laboratory result problems, arranging patient discharges, and optimizing the use of the hospital information system.