Non-clinical work counts: facilitating patient outflow in an emergency department

We conducted an observational study in an emergency department (ED) to acquire an in-depth understanding of the activities and processes involved in the ED patient outflow and the challenges encountered in the outflow coordination with heterogeneous and autonomous stakeholders within and across organisations. We identified that inefficient patient outflow not only led to overcrowding in the ED because patients could not be admitted to the ED, but it also affected the operation of other inpatient units and that of external organisations. Moreover, the overcrowding issue was found to be contingent on how efficiently the multiple, concurrent, and intertwined patient outflow work was coordinated. The patient outflow coordination work was primarily non-clinical, and invisible in the current information system. Therefore, we propose to make the non-clinical coordination outflow work visible and be supported in the information system as efficient outflow is crucial to the efficiency of the overall patient flow.