Improving patient satisfaction for patients with acute neurological symptoms by increased flow from the front door of hospital and more specific documentation in medical record notes: a quality improvement project

Patient experience is considered essential in evaluating healthcare quality. One of the most important parameters that influence patient satisfaction is perception of throughput time, defined as the time from hospital entrance to time of discharge. Throughput issues often start in the emergency department. This often contributes to waiting time for patients and task accumulation for staff. Our overall aim was to optimise throughput in a patient-centred manner for acute neurological patients arriving in the emergency department. We found two primary drivers for change: faster admission to the neurological subunit of the emergency department and improved documentation of three specific topics in the medical records (specific tentative diagnosis, specific treatment plan after CT/MRI and specifically addressing time of expected discharge). Using the plan–do–study–act method, we facilitated successfully changes through education, one-to-one talks, feedback, checklists and by drawing attention to the project. Patients admitted to the hospital after telephonic contact between admitting physician and neurologist arrived in the subunit with a delay of 34 min after arriving at the hospital compared with 89 min before the interventions. Patients unknown to the neurologist before arrival to the hospital arrived at the subunit with a delay of 107 min compared with 130 min before the intervention. The compliance with addressing each of three topics in the medical records showed a significant increase from a median of, respectively, 62%–100%, 45%–82% and 28%–72%. The project goal was achieved, as an increase in patient satisfaction of 27% from the baseline survey was seen, as well as a reduction in the proportion of patients mentioning waiting time in a negative way from 45% to 10%. This demonstrates that a low-cost structured approach can change the way doctors work, for the benefit of patients and staff in the emergency department.