Effects of multidisciplinary teamwork on lead times and patient flow in the emergency
department: a longitudinal interventional cohort study
Sammanfattning
BACKGROUND:
Long waiting times for emergency care are claimed to be caused by overcrowded emergency
departments and non-effective working routines. Teamwork has been suggested as a promising
solution to these issues. The aim of the present study was to investigate the effects of teamwork in a
Swedish emergency department on lead times and patient flow.
METHODS:
The study was set in an emergency department of a university hospital where teamwork, a multi-
professional team responsible for the whole care process for a group of patients, was introduced. The
study has a longitudinal non-randomized intervention study design. Data were collected for five
two-week periods during a period of 1.5 years. The first part of the data collection used an ABAB
design whereby standard procedure (A) was altered weekly with teamwork (B). Then, three follow-ups
were conducted. At last follow-up, teamwork was permanently implemented. The outcome measures
were: number of patients handled within teamwork time, time to physician, total visit time and number
of patients handled within the 4-hour target.
RESULTS:
A total of 1,838 patient visits were studied. The effect on lead times was only evident at the last
follow-up. Findings showed that the number of patients handled within teamwork time was almost
equal between the different study periods. At the last follow-up, the median time to physician was
significantly decreased by 11 minutes (p = 0.0005) compared to the control phase and the total visit
time was significantly shorter at last follow-up compared to control phase (p = <0.0001; 39 minutes
shorter on average). Finally, the 4-hour target was met in 71% in the last follow-up compared to 59%
in the control phase (p = 0.0005).
CONCLUSIONS:
Teamwork seems to contribute to the quality improvement of emergency care in terms of small but
significant decreases in lead times. However, although efficient work processes such as teamwork
are necessary to ensure safe patient care, it is likely not sufficient for bringing about larger
decreases in lead times or for meeting the 4-hour target in the emergency department.