Peter Korsten1, Bodo Sliwa, Matthias Kühn, Gerhard A Müller, Sabine Blaschke. 1. aDepartment of Nephrology and Rheumatology bManaging Board, Section 3, Management and Administration cInterdisciplinary Emergency Care Unit, University Medical Center Göttingen, Göttingen dDepartment of Systems and Software Engineering, Computing Faculty, Technical University Ilmenau, IImenau, Germany.
Abstract
OBJECTIVES: In emergency departments (EDs), overcrowding, workload complexity, and cost containment represent current operational problems. In this retrospective observational study, we analyzed the effects of a professional quality management (QM) system on patient flow, diagnostic validity, and hospital costs. MATERIALS AND METHODS: In 2005/2006, the main ED at the University Medical Center Goettingen was reorganized. A professional QM system according to DIN EN ISO 9001:2008 was introduced in 2008. In a retrospective observational study, we compared the number of cases, the spectrum of clinical diagnoses, the validity of diagnoses, and hospital costs in the ED before (2005) and 2 years after the introduction of the QM system (2010). RESULTS: In the ED at the University Medical Center Goettingen, the number of cases increased by 22.7% between 2005 and 2010. After the introduction of the QM system, a significant reduction in patients' length of stay within the ED was achieved (P<0.001). Furthermore, the rate of diagnostic errors for patients assigned for admission within the ED could be reduced significantly (P=0.002). A reduction of patient-related hospital costs of 8.9% was achieved by restriction of diagnostic tests according to standard operating procedures for each emergency diagnosis. CONCLUSION: The introduction of a professional QM system in EDs improves patient flow as well as quality of medical care and results in a significant reduction in hospital costs. Further analyses should evaluate the effects of QM on quality indicators in a prospective multicenter study. Validation of results has to be performed in a dynamic model for process simulation.
OBJECTIVES: In emergency departments (EDs), overcrowding, workload complexity, and cost containment represent current operational problems. In this retrospective observational study, we analyzed the effects of a professional quality management (QM) system on patient flow, diagnostic validity, and hospital costs. MATERIALS AND METHODS: In 2005/2006, the main ED at the University Medical Center Goettingen was reorganized. A professional QM system according to DIN EN ISO 9001:2008 was introduced in 2008. In a retrospective observational study, we compared the number of cases, the spectrum of clinical diagnoses, the validity of diagnoses, and hospital costs in the ED before (2005) and 2 years after the introduction of the QM system (2010). RESULTS: In the ED at the University Medical Center Goettingen, the number of cases increased by 22.7% between 2005 and 2010. After the introduction of the QM system, a significant reduction in patients' length of stay within the ED was achieved (P<0.001). Furthermore, the rate of diagnostic errors for patients assigned for admission within the ED could be reduced significantly (P=0.002). A reduction of patient-related hospital costs of 8.9% was achieved by restriction of diagnostic tests according to standard operating procedures for each emergency diagnosis. CONCLUSION: The introduction of a professional QM system in EDs improves patient flow as well as quality of medical care and results in a significant reduction in hospital costs. Further analyses should evaluate the effects of QM on quality indicators in a prospective multicenter study. Validation of results has to be performed in a dynamic model for process simulation.