Development of a Guideline to Alleviate Overcrowding in the Emergency Department of Phayakkhaphumphisai Hospital, Mahasarakham Province.

Abstract

Abstract

This action research aimed to develop a guideline to alleviate overcrowding in the Emergency Department of Phayakkhaphumphisai Hospital, Mahasarakham Province, using Donabedian’s conceptual framework in three dimensions: structure, process, and outcome. The study involved 378 service recipients and 25 healthcare personnel. The research was conducted from January to December 2024. Quantitative data were analyzed using descriptive statistics, paired t-test, and independent t-test.

The findings revealed that, after implementing the developed guideline, the average patient waiting time was significantly reduced by 48.7 minutes (p<0.001). Bed occupancy decreased from 89.4% to 76.8% (p<0.001). The newly established Fast Track system could serve an average of 28.4 non-urgent patients per day. The quality of care improved, as evidenced by a 37.1% reduction in complications and a decrease in 72-hour revisit rates from 8.7% to 5.2% (p<0.01). Treatment effectiveness increased with reductions in inpatient referral rates, diagnostic time, and treatment initiation time, while the emergency survival rate rose to 97.9% (p<0.05). Patient and relative satisfaction improved from 3.44 to 4.18 points (p<0.001), and staff satisfaction increased by 0.83 points, while work-related stress decreased by 0.84 points (p<0.001).

In conclusion, developing a guideline based on Donabedian’s systems theory effectively enhanced patient safety, treatment outcomes, satisfaction, and organizational sustainability.

Keywords : overcrowding, emergency department, service system development, patient triage, Fast Track