The effect of establishing a new, reorganized emergency department on quality of clinical healthcare and patient satisfaction

During the past few years, emergency services in Denmark have been reorganized following recommendations by the Danish Health and Medicines Authority. The goal is to improve the quality of the acute care of all patients, by organizing a single entrance to the emergency department with primary assessment and treatment in focus. This approach is thought to strengthen the initial diagnostic workup as well as ensuring a treatment plan for the patient before any transfer to the relevant specialist department. The quality of this service is enhanced by the presence of senior physicians at first patient contact contributing to a more precise and comprehensive referral and triage of patients and optimizing patient flow. Additionally, an early access to diagnostic capabilities and electronic patient safety solutions, e.g. electronic information display boards and electronic medical records, as well as increased competences of doctors and nurses, adds efficiency and safety to each patients need for acute care.
The overall aim of the thesis was to investigate the quality of healthcare and patient-perceived quality before and after the reorganization of an ED into a new emergency department with observation beds, and to determine whether a consistency was seen between the treatment given and the patients’ experience of the treatment. Study I describes the quality of care before and after the establishment of a new emergency department at Nykøbing Falster Hospital by measuring five common disease groups based on data from the National Indicators Project. The study showed an overall improvement of 48% (15/31) in the indicators. The greatest improvement was seen in stroke patients, which had been a special focus in the emergency department investigated. In Study II patient satisfaction in the emergency department was assessed by a questionnaire before and after the establishment of the new emergency department. In particular, there was a positive difference in the perceived waiting time and degree of staff collaboration in the new department. The shorter waiting on arrival was, however, matched by what the patients experienced as an excessive delay with regard to treatment and investigation. Study III examined the association between an index of health care indicators and the patient satisfaction that was examined in Study II. This showed no correlation, but there was a correlation between patient satisfaction and readmissions and mortality. In summary, we saw an overall improvement in healthcare quality and patient satisfaction after the establishment of the new emergency department at Nykøbing Falster Hospital. During the same period, a general improvement in the quality of emergency healthcare in Denmark is seen. The quasi-experimental design of this study makes it difficult to conclude whether the observed improvement is directly related to the establishment of the new emergency department; however, significant results seems to be associated to the specific initiatives in the reorganization. The development of consensus indicators for monitoring acute treatment in Denmark is recommended to facilitate new studies in the future.