The emergency department "carousel": An ethnographically-derived model of the dynamics of patient flow

Nugus, P; Forero, R; McCarthy, S; Mcdonnell, G; Travaglia, J; Hilman, K; Braithwaite, J

The emergency department "carousel": An ethnographically-derived model of the dynamics of patient flow

Nugus, P Forero, R McCarthy, S Mcdonnell, G Travaglia, J

Hilman, K Braithwaite, J

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Publication Type:: Journal Article
Citation:: International Emergency Nursing, 2014, 22 (1), pp. 3 - 9
Issue Date:: 2014-01-01

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Field	Value	Language
dc.contributor.author	Nugus, P	en_US
dc.contributor.author	Forero, R	en_US
dc.contributor.author	McCarthy, S	en_US
dc.contributor.author	Mcdonnell, G	en_US
dc.contributor.author	Travaglia, J https://orcid.org/0000-0002-7537-0466	en_US
dc.contributor.author	Hilman, K	en_US
dc.contributor.author	Braithwaite, J	en_US
dc.date.available	2013-01-10	en_US
dc.date.issued	2014-01-01	en_US
dc.identifier.citation	International Emergency Nursing, 2014, 22 (1), pp. 3 - 9	en_US
dc.identifier.issn	1755-599X	en_US
dc.identifier.uri	http://hdl.handle.net/10453/118714
dc.description.abstract	Emergency department (ED) overcrowding reduces efficiency and increases the risk of medical error leading to adverse events. Technical solutions and models have done little to redress this. A full year's worth of ethnographic observations of patient flow were undertaken, which involved making hand-written field-notes of the communication and activities of emergency clinicians (doctors and nurses), in two EDs in Sydney, Australia. Observations were complemented by semi-structured interviews. We applied thematic analysis to account for the verbal communication and activity of emergency clinicians in moving patients through the ED. The theoretical model that emerged from the data analysis is the ED "carousel". Emergency clinicians co-construct a moving carousel which we conceptualise visually, and which accounts for the collective agency of ED staff, identified in the findings. The carousel model uniquely integrates diagnosis, treatment and transfer of individual patients with the intellectual labour of leading and coordinating the department. The latter involves managing staff skill mix and the allocation of patients to particular ED sub-departments. The model extends traditional patient flow representations and underlines the importance of valuing ethnographic methods in health services research, in order to foster organisational learning, and generate creative practical and policy alternatives that may, for example, reduce or ameliorate access block and ED overcrowding. © 2013 Elsevier Ltd.	en_US
dc.relation.ispartof	International Emergency Nursing	en_US
dc.relation.isbasedon	10.1016/j.ienj.2013.01.001	en_US
dc.subject.classification	Nursing	en_US
dc.subject.mesh	Humans	en_US
dc.subject.mesh	Patient Admission	en_US
dc.subject.mesh	Patient Discharge	en_US
dc.subject.mesh	Crowding	en_US
dc.subject.mesh	Models, Organizational	en_US
dc.subject.mesh	Anthropology, Cultural	en_US
dc.subject.mesh	Emergency Service, Hospital	en_US
dc.subject.mesh	Triage	en_US
dc.subject.mesh	Efficiency, Organizational	en_US
dc.subject.mesh	Organizational Culture	en_US
dc.subject.mesh	New South Wales	en_US
dc.subject.mesh	Interviews as Topic	en_US
dc.title	The emergency department "carousel": An ethnographically-derived model of the dynamics of patient flow	en_US
dc.type	Journal Article
utslib.citation.volume	1	en_US
utslib.citation.volume	22	en_US
utslib.for	1110 Nursing	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Strength - CHSP - Health Services and Practice
utslib.copyright.status	closed_access
pubs.issue	1	en_US
pubs.publication-status	Published	en_US
pubs.volume	22	en_US

Abstract:

Emergency department (ED) overcrowding reduces efficiency and increases the risk of medical error leading to adverse events. Technical solutions and models have done little to redress this. A full year's worth of ethnographic observations of patient flow were undertaken, which involved making hand-written field-notes of the communication and activities of emergency clinicians (doctors and nurses), in two EDs in Sydney, Australia. Observations were complemented by semi-structured interviews. We applied thematic analysis to account for the verbal communication and activity of emergency clinicians in moving patients through the ED. The theoretical model that emerged from the data analysis is the ED "carousel". Emergency clinicians co-construct a moving carousel which we conceptualise visually, and which accounts for the collective agency of ED staff, identified in the findings. The carousel model uniquely integrates diagnosis, treatment and transfer of individual patients with the intellectual labour of leading and coordinating the department. The latter involves managing staff skill mix and the allocation of patients to particular ED sub-departments. The model extends traditional patient flow representations and underlines the importance of valuing ethnographic methods in health services research, in order to foster organisational learning, and generate creative practical and policy alternatives that may, for example, reduce or ameliorate access block and ED overcrowding. © 2013 Elsevier Ltd.

Please use this identifier to cite or link to this item:

http://hdl.handle.net/10453/118714