Effectiveness of Manchester triage flow model regarding patients’ waiting time in Bahria international hospital Lahore, Pakistan

Waiting Time in Bahria International Hospital Lahore, Pakistan. Cardiometry; Issue No. 29; November 2023; p. 95-98; DOI: 10.18137/cardiometry.2023.29/9598; Available from:

Clinicians use the Manchester Triage System, a clinical risk management tool, to properly manage patient flow when clinical need exceeds capacity(Singh & Awasthi, 2022). A group of emergency nurses and doctors from the general, paediatric, and ophthalmology emergency departments in Manchester established the Manchester Triage Group in November 1994 (Cicolo, Nishi, & Peres, 2020). A growing number of patients, ranging from those with mild illnesses and injuries to those with serious trauma and life-threatening disorders, visit emergency rooms every day. Patients must be seen according to clinical priority rather than attendance order in order to protect patient safety (Pryce, Unwin, Kinsman, & McCann, 2021). The Manchester Triage System is used to maintain a consistent method of prioritising and assessing patients, allowing for thorough audits and improved patient safety. Globally, emergency departments (EDs) are seeing increased challenges due to an increase in patients and an inability to build capacity to keep up with demand. In the backdrop, hospital resources are being squeezed. Consequently, ED overcrowding has spread globally and become a common problem (Zachariasse et al., 2021). One of the most popular triage systems in Europe is the Manchester Triage System, which prioritises patients in the ED according to five levels: level 1 (red), immediate;

Study Design:

Cross Sectional descriptive study design.

Study Period:

Two months 01-July-2023 to 01-August-2023.

Sample Size:

Methodology

All the information was provided via the hospital’s electronic medical record and patient monitoring system, which was utilised in the ED from 01-July-2023 to 01-August-2023. Each patient’s stay duration, wait time (from the time of registration to the beginning of nurse preparation), and process time (from the time a nurse allocated a new patient to a box to the time this patient was sent home or moved to an observation unit) were meticulously documented. The crucial variable was the median process time, which was independently determined for patients discharged straight from the ED and those transferred to the observation unit. As auxiliary variables, the median length of stay and median waiting time were also assessed. These included the daily left without being seen (LWBS) rate, the daily 72-h revisit rate, and the daily ED mortality rate. These variables could have unanticipated effects on the standard of care patients get. Finally, the interpretation of the data for the waiting time at the emergency department may be complicated by the following potential confounders:

Results

The median time from arrival to information desk attendance was 9 minutes, with a range of 6 to 13 minutes. This duration was highest for urgent cases at 12 minutes (ranging from 6 to 18 minutes), and lowest for immediate cases at 5 minutes (ranging from 2 to 9 minutes).

The median time from arrival to triage for all cases combined was 18 minutes, with a range of 12 to 30 minutes. This duration was highest for less urgent cases at 25 minutes (ranging from 20 to 30 minutes), followed by urgent, emergent, and immediate cases. Immediate cases had a median time of 9 minutes (ranging from 4 to 15 minutes) between arrival and triage.

For shifting, the highest median time was 30 minutes (ranging from 27 to 40 minutes) for less urgent cases, while the lowest median time was 11 minutes (ranging from 5 to 18 minutes) for immediate cases. The total median time for all cases from arrival to shifting was 25 minutes (ranging from 15 to 30 minutes).

Discussion

The current study shows how a clinical procedure, particularly the treatment of patients, can be efficient and greatly increase the value of waiting time. This degrades the flow and quality and is removed. By further minimising the time spent waiting between phases and giving the next user in the process exactly what they need, quality and productivity increase. Staff members on the front lines are trained to spot waste and to enhance and standardise their workflow. The flow model has been tried to be implemented in the ED before, but the results weren’t always thought to be clinically relevant. Each organization’s own local environment is taken into account as generic lean principles are interpreted and modified. Organizations who have correctly applied these ideas have not only produced statistically significant outcomes, but also improvements that are pertinent to the therapeutic setting. The way this strategy was used in the current study should be highlighted because it could mean the difference between failure and success. Success depended on the dedication of the ED management team as well as the formation and empowerment of a multidisciplinary team of frontline employees. Frontline staff members were given more freedom to develop solutions to issues that led to waste, delayed flow, and poorer quality care in the ED because they have more knowledge of the systems. The new procedure was more enthusiastically adopted by the rest of the staff as a result of the bottom-up rather than top-down strategy, and successful implementation was easier to achieve. The ED executive team played two roles: they assisted in providing the means for implementation and got involved in problems that came up during analysis and implementation, serving as genuine methodology consultants. In the current study, it was also noteworthy that the availability of internal knowledge and abilities eliminated the need for an external consultant. Staff members may not accept or get accustomed to being observed or punished and may be unwilling to have outsiders meddle with their regular activities.

Conclusion

The current study, in particular in those medical regions lacking additional staff or beds, illustrates the impact of patient flow in the emergency department. Despite an increase in daily visits, this improvement can be made without a reduction in the quality markers examined. This quantitative study’s goal was to determine how an ED patient flow mod- el and an ESI patient triage level affected the median monthly wait times for patients. Between July 01, 2023, and August 01, 2023, data was gathered from an ED at Bahria International Hospital Lahore, Pakistan using the ED triage patients model model. Leaders of the hospital emergency department can use the study’s findings to cut down on patient wait times. People gain from prompt ED care and treatment. As hospital administrators create plans to enhance ED patient flow and comprehend how ESI triage levels affect patient wait times, society might gain.

Recommendations

I recommend further research into the following topics: Given that the study only involved one hospital in Lahore, Pakistan, I first suggest duplicating it in another area to see if the results are consistent. The consequences of patient wait times for a split-flow patient model and an ESI patient triage level might be compared, as a second suggestion. A comparison study could provide more information to ED managers about which flow model would have the most effect on patient wait times.

Contributions

Ethics approval

Approval was obtained from the ethics committee Bahria International Hospital, Lahore, Pakistan. The procedures used in this study adhere to the tenets of the Declaration of Lahore, Pakistan.

Conflict of interest

The authors have no competing interests to declare that are relevant to the content of this article.

Funding

No funding was acquired.