Objectives: The primary objective of   this study was to evaluate the impact of an electronic tracking board feature   encouraging staff to prompt optimal patient location on total stretcher time   (TST) amongst patients moved to a chair in an internal emergency department   (ED) waiting room. As a secondary objective, we also sought to identify   facilitators and barriers to the tool's use amongst the ED staff. 

Methods: Using an administrative database, a retrospective cohort design was used to   compare TST between visits where the tool was used and not used amongst   patients relocated from initial assessment space to a chair over an 11.5   month period. A mixed-methods design was used to investigate facilitators and   barriers to the tool's use amongst the ED staff. Response proportions were   used to report Likert scale questions; thematic analysis was used to code   themes. 

Results: A total of 56,852 patients met the inclusion criteria and   were moved to a chair. The tool was used 4,301 times, with "OK for   chairs" selected for 3,917/56,852 (6.9%) patients and "not OK for   chairs" selected 384/56,852 (0.7%) times. Patient characteristics were   similar between both groups. Median interquartile range (IQR) TST amongst   patients moved to a chair via the prompt was shorter than when the prompt was   not used (148.2 (112.6) mins vs 154.4 (115.4) mins, p = 0.005). A total of 125   questionnaires were completed; 95% of staff were aware of the tool and 70%   agreed/strongly agreed the tool could improve ED flow. Commonly reported   physician barriers to use were forgetting to use the tool; common nursing   barriers were lack of chair space and increased workload. 

Conclusions: Despite   low function use, prompt use was associated with reduced TST amongst ED   patients relocated to a chair.

Authors: Dirk Chisholm, Dongmei Wang, Thomas A. Eich, Matthew Grabove, Kelli Sherrlock, Eddy Lang