Know the flow: A mixed method analysis of patient flow through a regional Emergency Department.

Access block, emergency department (ED) crowding, and ambulance ramping are a modern-day epidemic for emergency clinicians. Evidence demonstrates that these phenomena increase patients’ length of stay (LOS) and contribute to increased patient morbidity and mortality, whilst annual national reports show that EDs are busy places that keep getting busier.

There has been heavy investment in government initiatives and patient flow management systems, but ED LOS rates continue to exceed targets. Tasmania is no exception to this trend. The Launceston General Hospital (LGH) serves a population of approximately 143,500 and has been experiencing steadily climbing admission rates. Average ED LOS was 22.5 hours for patients admitted to the LGH in 2016-17, whilst the average ED LOS for all patients was around 4 hours longer than the national average.

This project aimed to identify “bottle necks” that contribute to crowding in the ED. Observational data was collected over four consecutive 24 hour periods to measure and track the mean time spent at each stage of the patient journey through the ED at the LGH. More than 350 patient journeys were tracked and key time points in service delivery recorded. Qualitative data obtained from a focus group with the nursing students who undertook the observational data collection provides unique insights into what was done well in the ED and the processes that could be improved. This presentation will focus on the key findings from the project, particularly the identified delays in patient flow through and out of the ED. Recommendations for improvement of service delivery will be discussed.


Ms Alex Pryce

Alex Pryce is a Registered Nurse and Associate Nurse Unit Manager (ANUM) at the LGH ED. Alex is currently undertaking this project as a part of her Bachelor of Nursing with Honours program, under the supervision of Dr Damhnat McCann and Ms Maria Unwin. Alex lives in Launceston and enjoys camping with her young family, lego building, mountain biking and running. In her spare time she dabbles in tutoring for the School of Health Sciences and assisting in the high fidelity simulation lab for the Launceston Clinical School.