Development of a Management Model for Critical and Urgent Emergency Patients to Enhance Service Accessibility Within 60 Minutes at the Emergency Department, Nong Muang Khai Hospital, Phrae Province

Abstract

This research and development study aimed to: 1) analyze the situation and factors causing delayed service accessibility, 2) develop a management model for critical and urgent emergency patients by an interdisciplinary team, and 3) evaluate the effectiveness of the model on service accessibility within 60 minutes at the Emergency Department, Nong Muang Khai Hospital, Phrae Province. Guided by System Theory integrated with the PDSA quality cycle, the study was conducted across three phases. The sample consisted of 46 critical and urgent emergency patients. Research instruments included a Clinical Practice Guideline, Standing Orders, time-motion and incident logs, and satisfaction evaluation questionnaires. Data were analyzed using descriptive statistics, including frequency, percentage, mean, and standard deviation.

The results revealed that: 1) The situational analysis phase identified a critical bottleneck in the exit flow process (Exit Block), where the interval from physician disposition to actual emergency department departure averaged 46.13 minutes (S.D. = 39.61, Min = 3 mins, Max = 255 mins). The primary cause was clinical complexity 62.50%, compounded by delays in supporting systems. 2) The developed innovation, the NMK-ER Model, emphasized proactive patient flow management and visual management using color coding. And 3) After model implementation, the total length of stay decreased from 70.11 minutes (S.D. = 46.33) to 42.15 minutes. Service accessibility within 60 minutes increased from 56.52% to 86.96%. Regarding clinical outcomes, safety incidents, ER mortality, and critical medication errors were reduced to zero. The under-triage rate dropped to 2.17%. The overall satisfaction of stakeholders was at the highest level ( = 4.63, S.D. = 0.49).