1. Translating an Emergency Department Wait Time Study to a Quality Improvement Project: The Story of RPIW #51 Sachin Trivedi and Tim West Medical Student, University of Saskatchewan Kaizen Operations Specialist, Saskatoon Health Region www.qualitysummit.ca #QS14

2. Introductions Sachin Trivedi Medical Student University of Saskatchewan Tim West Kaizen Operations Specialist Saskatoon Health Region 3. Our Discussion Discuss our experiences conducting and then translating a medical student research project into a quality improvement/kaizen project (RPIW) in the ED at St. Pauls Hospital Research project focused on how patients wait in line before being registered and triaged (Royal University Hospital and St. Pauls Hospital) Rapid Process Improvement Workshop (RPIW) focused on reducing the lead time from patients entering the ED to being assigned a bed by 50% as well as enhancing patient safety and satisfaction. 4. In the Beginning In June 2013, we started a research project aimed at identifying the length of times patients wait prior to registration and triage We sought to characterize these times and compare them against CTAS Recommendations These pre-triage times were measured at RUH and SPH Table 1 CTAS Classifications and Time Recommendations CTAS Score Classification Time to Physician Recommendation 1 Resuscitation Immediately 2 Emergent 15 Minutes 3 Urgent 30 Minutes 4 Less Urgent 1 Hour 5 Non Urgent 2 Hours 5. One piece of the puzzle 6. The Study A single observer was used to measure the pre-triage times We defined this time as the period between when a patient first entered the ED to when they were formally registered and triaged CTAS scores were obtained from the electronic record Patients arriving via EMS were excluded A total of 536 patients were timed Of these, 11 had left the line without being triaged 7. Results Table 2 Median wait times by subject characteristics Characteristic N Median time (IQR) - minutes Range p-value* All subjects 525 13.0 (2.9, 27.6) 0.05, 98.6 NA Non-triaged subjects 11 31.4 (21.0, 47.0) 10.0, 68.5 NA By age group Infant (2012-2013) 34 5.7 (0.38, 16.0) 0.05, 72.2 0.009 Child (2007-2011) 39 8.2 (1.6, 16.2) 0.05, 43.8 Preteen (2001-2006) 25 10.8 (6.5, 19.8) 0.05, 73.3 Teen (1995-2000) 26 12.5 (3.6, 24.2) 0.12, 63.3 Adult (1948-1994) 307 15.8 (3.0, 29.9) 0.05, 98.6 Elderly (1914-1947) 94 15.1 (5.3, 30.5) 0.05, 76.3 By time of day Morning (07:30-11:59) 147 14.6 (4.2, 23.8) 0.05, 79.8