Streamlining and Patient Flow at the Emergency Department- Al-Aqsa Hospital in the Gaza Strip.

Husam Mahmoud Mohammed Abu Olwan
حسام محمود محمد أبوعلوان
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Al-Quds University
Introduction and aim of the study Emergency Departments face significantly growing problems worldwide in terms of demand for high-quality services and timely care with an inability to flex the resources to meet the increasing demand. This study looks to assess the streamlining status at the emergency department at Al-Aqsa Hospital and to identify challenges and opportunities for improving these services. Study methodolgy A mixed-methods approach has been used including a patient tracking checklist, applied to 385 randomly selected patients with a response rate of 96%, followed by checking patients’ records. A staff questionnaire was filled out by 30 participants complemented with two focus group discussions and seven key informant interviews. The SPSS program was used for the analysis of quantitative data and the open coding thematic analysis technique was used for qualitative analysis. Findings and results Findings show that males and females almost equally attend the emergency department, however, 60% of them frequently visit the emergency department at the hospital. While only 8.8% of attendants to the emergency department arrived by ambulances, 81% arrived by a private car or a taxi. The peak of patient flow at the emergency department is between 9 to 12 am and between 4-9 pm. The vast majority of cases present to the department are non-emergency cases (76%). Despite its importance, vital signs haven’t been measured for almost half of cases. For example, blood pressure and body temperature were measured in only 50% of cases, nevertheless, the oxygen concentration was measured only for 4% and the level of consciousness was assessed only for 1.4% of the attendants. Appropriate triage was only performed for 14%, similarly, appropriate documentation was observed on only 30% of the cases. One-third of the time consumed on investigations (mean=36 min). Streamlining status as has been measured using proxy indicators moderate scale, as 65% have met the criteria of appropriate streamlining. Females and traumatize patients had better-streamlining outcomes than others, and older received more streamlined serves than younger ones and the differences were statistically significant. Also, the acuity of patients' illness contributed to streamlining the services. Additionally, beneficiaries presented in the morning shift showed better-streamlining results. Of the total attendants to emergency services, only 7% are admitted to the hospital, two thirds were sent home. Conclusion It is important to control the utilization of the emergency services for non-emergency purposescases through activating primary health care services and outpatient departments. Also, strengthening triage services and having a stable well-trained and experienced team dedicated to emergency departments is a must.