Quality improvement program in an emergency department.

Objective: To describe the quality assurance/improvement program in our emergency department ED.

Methods: This program involved monthly data collection and analysis, data-driven process change, staff education in the core concepts of quality, and data reanalysis from the years 2003 to 2006 at the King Abdul-Aziz Hospital, Al-Ahsa, Kingdom of Saudi Arabia. Data captured during the program included census data, chart review, and focused clinical audits. Continuous quality improvement measures collected at the beginning of the program and quarterly included: 1) quality indicators (length of stay [LOS] and rates of left against medical advice [AMA] or left without being seen [LWBS]), 2) percentage of patients that stay > or =3 hours in ED, unscheduled returns within 48 hours, inter-hospital transfer data, sentinel events tracking rates, and 3) nature of patient complaints.

Results: During the study period, the program demonstrated improvement in all measured areas. Despite an increase in patient volume of 47% to 51,698 visits/year, the mean monthly LOS remained static, the unscheduled returned visits dropped by 50% (2% to 1%), and patients leaving AMA decreased from 1.5% to 1.2%, and LWBS decreased from 1.6% to 0.8%. The rate of complaints dropped by 5 fold (1.3 per 1000 patients to 0.25).

Conclusion: Our program demonstrated improvement in all the measured parameters.