Reorganization of emergency department care by levels of urgency: impact on effectiveness and quality indicators

Sánchez M, Asenjo M, Gómez E, Zabalegui A, Brugada J

Objective: To analyze the impact of reorganizing an emergency department using

health care effectiveness and quality indicators as outcome measures.

Methods: Setting: tertiary care urban hospital. The emergency department switched

from organization by specialties (medicine, surgery, trauma) to organization by

assignment of spaces to Andorran Medical Triage (MAT) levels (I, II, III, and IV-V) without

regard for specialty area and without changing available resources. Study periods:

preintervention (December 1, 2009, to January 15, 2010) and postintervention

(December 1, 2010, to January 15, 2011). Effectiveness indicators: number of visits daily,

triage time, wait time, length of emergency department stay, percentage of admissions.

Quality indicators: objective—number of patients leaving without being seen, revisits,

and mortality; subjective—complaints.

Results: After reorganization significantly more patients were seen daily (202 vs 187

preintervention, wait time was shorter (96 minutes vs 115 minutes), fewer patients were

admitted (19.4% vs 22.9%), and fewer left without being seen (3.97% vs 5.25%)

(P<.05, all comparisons). Triage time did not vary between the 2 periods, and the revisiting rates were similar (4.69%, postintervention; 5.39%, preintervention; P=.07). Mortality increased after reorganization (to 0.48% vs 0.33% preintervention, P<.05), although the mortality rate remained low in comparison with previously published series. The number of complaints fell (to 0.2% from 0.4% before reorganization, P<.05). Conclusions: Reorganizing the emergency department by levels of urgency facilitated the departments ability to see more patients and led to improvements in nearly all of the quality indicators analyzed.

Asenjo M, Brugada J, Gómez E, Sánchez M, Zabalegui A