Approaches and Solutions to Hospital Emergency Department Overcrowding Including Failure Mode and Effect Analysis as a Risk Assessment Technique of Real-time Locating System
Al Essa, Fares Mohammed
Thesis or dissertation
University of Exeter
Emergency Departments (ED) are highly dynamic environments comprising complex multi-dimensional patient-care processes. In recent decades, there has been increased pressure to improve ED services, while taking into account various aspects such as clinical quality, operational efficiency, and cost performance. Overcrowding has become a major barrier to receiving a proper and timely emergency care in many acute hospitals throughout the world. Patients often face long waiting times to be seen and treated. Those who require admission may even wait longer. The scope of this research is to focus on ED factors that lead to overcrowding and their management. Technology is being cited as one of the management tools, specifically the utilization of Radio Frequency Identification (RFID) for tracking patients as their journey progresses through an ED. Like any technology, RFID has potential and pitfalls. The author chose to use Failure Mode and Effect Analysis (FMEA) as a tool to explore the possible failures of RFID technology as it is utilized in one of the ED in Riyadh Military Hospital (RMH). This particular ED has been used as a case study to explore those failures and, with the use of FMEA, propose a set of recommendations to address those failures and improve the design and implementation of RFID. The experience of RMH-ED was explored through interviews and a survey in which 100 participants took part. The survey touched upon various aspects of this experience. This was due to the various roles of the surveyed staff who were involved with this technology. These roles ranged from front line clinical staff to administrative staff, management staff and technical support staff. Data analysis showed convincing evidence of the positive impact RFID had on managing ED overcrowding. However, and as expected, there are some pitfalls and failures that FMEA helped identifying and suggested potential solutions to them. RFID is a small link in the chain of other technological innovations and solutions. It is by no means capable of solving the problems associated with ED overcrowding by itself. Most of the search carried out by the author identified large variation in approaches to dealing with the issue of ED overcrowding. Those ranged from applying more human resources to altering the pathways of managing patients journey through healthcare system to applying more intermediate layers of management to ease the pressure of the Emergency departments. Other approaches included some aspects of technology such as development of early warning systems that have not been widely adopted and remained as isolated efforts.
PhD in Engineering