Objectives: To identify factors leading to the delay of transfer of admitted patient from the emergency room holding area to heir respective wards at Vicente Soto Memorial Medical Center. The author would like to focus on the intervening factor affecting patient's turn-over from the emergency room holding area to the ward and to determine the time lag in the transport of patients.
Design: This is a retrospective, descriptive study.
Setting: The emergency room holding area of Vicente Sotto Memorial Medical Center
Participants: All admitted cases at the ER from the different specialty departments who were transferred to he emergency room holding area from April 1, 2007 to September 30 2007.
Intervention: Review of logbooks in the emergency room holding area where all the admitted patients are recorded including the time hey were admitted at the area and transferred to the wards. Data collection form was given to he health personnel on duty and accompanying of admitted patients identified to be staying for more than 24 hours in the area containing some question regarding the reason of delayed transfer.
Main Outcome Measures: The different factors leading to he delay of transfer of admitted patients from emergency room holding area to their respective wards is identified and evaluated. Moreover, the average number of patients that can be transported for each specialty department per month are ado determined.
Results: Reasons leading to the delay of transfer of admitted patients from the emergency room holding area to ward may come from different areas. Factors from the patient, health facility, health personnel & organizational factors were identified in the study. These include the lack of support from family and friends for the patient, no accompanying, lack of financial capacity, lack of medicines and materials for OR use and inability to comply with the laboratory examinations. In the health facility, unavailability of beds at the ward and stretchers for transport and delayed laboratory services were the major factors causing delay. Lack of transport orderlies and ER holding area staff, poor follow-up of patients by the admitting resident and nurses on duty, incomplete carrying of doctor's orders by nurses and delayed responses to referrals by specialty departments were common. Organizational factors include the absence of criteria or guidelines in the ER holding area admissions and transport as well as the over-all system in the operation of the area. A total of 437 patients (21.10%) of the 2,071 of the admitted patients at the area were transported to their respective ward assignments in approximately 10 hours but an average of 17 patients can be transported in that time period. Only 27 (6.18%) of patients were transported in more than 24 hours.
Conclusion: It can be concluded that reasons leading to the delay of transfer of admitted patients from the ER holding area to ward is multifactorial. Therefore causative factors could not be viewed independently, rather, they should be considered as interrelated variables. Unavailability of hospital facilities, shortage in manpower, changing roles of ER holding area staff and lack of clear-cut guidelines in the operation of the area greatly affect patient's turn-over. Nevertheless, the emergency room holding area is decongesting the emergency room by 17 patients in less than 24 hours.
To identify the factors leading to the delay of transfer of admitted patients at emergency room holding area to their respective wards and to determine the average numbers of hours of their stay at the area before they are transferred.
1. To determine the average number of hours ER holding area admitted patients are transferred to their wards in a 24 hours time period.
2. To determine to their the average number of patients that can be transported to the ward in a 24 hour time period.
3. To determine the number of patients that can be transported to the wards for each specialty department per shift.
4. To determine the total number of admissions for each specialty department per month.
5. To evaluate the reason affecting transfer of patients from ER holding area to ward.