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Study on Turnaround Time in Emergency Department at Yatharth Hospital, Greater Noida

This study focuses on monitoring and analyzing the turnaround time and workflow processes in the Emergency Room (ER) of Yatharth Hospital. The research includes observing the time taken for various stages from patient arrival to assessment by nurses and doctors, as well as the transfer of patients to critical areas and wards. Factors contributing to delays in turnaround time were identified, such as doctor availability, communication issues, and operational challenges. The findings aim to improve efficiency and quality of care in the ER.

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Study on Turnaround Time in Emergency Department at Yatharth Hospital, Greater Noida

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  1. STUDY ON TURNAROUND TIME IN EMERGENCY DEPARTMENT YATHARTH HOSPITAL ,GREATER NOIDA PRESENTED BY: DR. SHIVI SABBARWAL ROLL NO. :(PG/21/100) MENTOR:DR. ROHINI RUHIL IIHMR DELHI

  2. MENTOR APPROVAL

  3. INTRODUCTION The primary goal of the emergency services are to minimize early mortality and complications, although longer-term morbidity, quality of life and late mortality may also be influenced by early actions. • Turnaround time is the amount of time it takes to complete a process. It is the time from the moment a request is made or a process is started to the time when the request is fulfilled or the process is complete. • 5

  4. WORKFLOW OF RECEIVING PATIENTS IN ER OF YATHATH HOSPITAL Security at the gate Informs by telephone when sees a vehicle going towards emergency Security at triage informs by a call bell Yes Intimation available to CMO Receiving patient in emergency CMO informs HCC/CCU to be ready No Informs cardiac consultant to be on stand by GDA receives patient from the vehicle to trolley Patient is wheeled In to triage Met by CMO/SN at the entrance Informs GDA/ nurse to be ready at emergency reception Gives relevant direction to triage nurse for emergency preparedness of unit / equipment

  5. OBJECTIVES To understand the workflow process of ER department in Superspeciality Hospital. • To monitor turnaround time and waiting time in the Emergency Room. •

  6. METHODOLOGY Study Design- • Prospective Observational Mixed Method. . Study Population- • The study population included the patients who reported in the Emergency Room of Yatharth Hospital, Greater Noida. Study Duration- • The study duration was 3 months. Sampling Technique- • Convenience Sampling was done. Selection Criteria- • This study included all those patients who were presented with the emergency in ER and excluded those patients who visited ER for dressing, injections and Daycare. 8

  7. Study Tool - The study tool used was a checklist that was made for this study. • . Sample Size - 500 sample size was taken. • Ethical Consideration -All the information collected was taken under the guidance of the Opertations Department and the Emergency Department. All information received has been kept confidential. • STRENGTHS and LIMITATIONS - • The study's merits were that it covered all patients who were presented with an emergency in the ER department, and the precise time of each action was recorded. The study's limitations were that it did not include patients who went to the emergency room for dressings, injections or daycare. 8

  8. CHECKLIST PREPARED FOR MONITORING THE TURNAROUND TIME IN ER DEPARTMENT DATE OF ARRIVAL TIME OF ARRIVAL AT ER TIME WHEN FIRST ATTENDED BY ER NURSE TIME WHEN ASSESMEN T COMPLETE D BY NURSE NURSING ASSESMENT TIME MINS TIME WHEN FIRST ATTENDED BY ER DOCTOR TIME WHEN FIRST ASSESMENT COMPLETED BY ER DOCTOR DOCTOR ASSESMEN T TIME MINUTES TRANSFER OUT TIME FROM ER IPD ADMISSION/ WARD TAT IN ER TAT IN ER(MINS)

  9. RESULTS 1. TURNAROUND TIME OF ASSESING PATIENTS PRESENT IN ER BY DOCTORS/NURSES. 0:57:36 0:50:24 0:43:12 0:36:00 0:28:48 0:21:36 0:14:24 0:07:12 0:00:00 MIN MAX AVG NURSING 0:03:00 0:50:00 0:25:00 DOCTORS 0:05:00 0:40:00 DOCTORS 0:20:00 NURSING 9

  10. 2. DURATION OF TRANSFERING OUT OF PATIENTS FROM ER. 4:48:00 AM 4:22:00 AM 4:19:12 AM 3:50:24 AM 3:21:36 AM 2:52:48 AM 2:33:30 AM 2:24:00 AM 1:55:12 AM 1:26:24 AM 12:57:36 AM 12:45:00 AM 12:28:48 AM 12:00:00 AM TRANSFER FROM ER MIN MAX AVG Series1 12:45:00 AM 4:22:00 AM 2:33:30 AM 10

  11. 3.TURNAROUND TIME FOR TRANFERING PATIENTS TO CRITICAL /WARDS 3:50:24 3:21:36 2:52:48 2:24:00 1:55:12 1:26:24 0:57:36 0:28:48 0:00:00 min max avg wards 0:30:00 3:30:00 2:00:00 critical areas 0:10:00 2:28:48 1:19:24 11

  12. OVERALL FACTORS ASSOCIATED WITH DELAY IN TURAROUND TIME DOCTORS  UNAVAILIBILTY OF DOCTORS(CONSULTANT)  RTA/MLC CASES.  MASS CASUALITY • COMMUNICATION FAILURE BETWEEN NURSING AND FRONT OFFICE STAFF. NURSING  NO BED AVAILABILITY WARDS  GDA/HK RELATED ISSUES OPERATIONAL  HIGH WAITING TIME FOR LIFTS.  NON AVAILIBITY OF VENTILATORS.  OPERATIONAL BREAKDOWN

  13. DISCUSSION A time and motion study was done in the ER of Yatharth Hospital to check the proper flow of ER within the time set by the standards and to ensure proper functioning of ER . The checklist that was made for this study includes - Date, UHID Patient’s name Age Time of arrival at ER Time when first attended by ER Nurse Time when assessment was completed Time when first attended by ER doctor Time when assessment was completed by ER Doctor 10. Transfer out Time 11. Admission/Discharge. • • 1. 2. 3. 4. 5. 6. 7. 8. 9. 12

  14. After reviewing the data, it was discovered that the - Average time taken by a nurse to complete the assessment of a patient is 10 minutes • Average time taken by a doctor to complete the assessment of a patient in the emergency room is 13 minutes. • Average time taken to transfer patient to critical areas is 1 hour 19 min . • Average time taken to transfer patient to Wards is 2 hours . • Average TAT of Emergency Process is min 02 hour 33 minutes , which give satisfactory outcome to the study. • Yatharth Superspeciality Hospital is a 400 beded hospital that likely adheres to the emergency guidelines. It is critical to follow the guidelines for a hospital's smooth operation, and Yatharth Superspeciality Hospital is doing good in order to provide patients with the level of Satisfaction. •

  15. CONCLUSION . The time spent on various activities in the emergency department of a hospital was documented to see the workflow and waiting time of ER. • A satisfactory result was found after the study was done. In the ER, the staff were well-trained, and doctors were present while performing a wide range of activities in the ER, the turnaround time was also good. • 15

  16. REFRENCES • Matthias Azzopardi, Marija Cauchi, Karl Cutajar, Robert Ellul, Charles Mallia-Azzopardi & Victor Grech BMC Research Notes volume 4, Article number: 421 (2011)https://bmcresnotes.biomedcentral.com/articles/10.1186/1756-0500-4-421 • Ann Hendrich, RN, MSN, FAAN, Marilyn P Chow, DNSc, RN, FAAN, Boguslaw A Skierczynski, PhD, and Zhenqiang Lu, PhDhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3037121/ • Chiara Dall'Ora 1, Peter Griffiths 2, Joanna Hope 3, Jim Briggs 4, Jones Jeremy 5, Stephen Gerry 6, Oliver C Redfern 7https://pubmed.ncbi.nlm.nih.gov/33812297/  https://nabh.co/Images/PDF/Emergency_Brochure.pdf  https://nabh.co/Emergency_Intro.aspx  Dr. Bincy Pothen1, Mr.Shiv Shankar Tiwari2Dr. Bincy Pothen1, Mr.Shiv Shankar Tiwari2  Mikayla Fieri; Nathan F. Ranney; Eric B. Schroeder; Eileen M. Van Aken; Amanda H. Stonehttps://ieeexplore.ieee.org/document/5469650  David Sinreich, Yariv Marmor  Journal of Health Organization and Management ISSN: 1477-7266Article publication date: 1 April 2005 https://www.researchgate.net/publication/7641746_Ways_to_reduce_patient_turnaround_time_and_improve_service_quality_in_emerge ncy_departments

  17. THANKYOU..... 19

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