Improving Timeliness of Internal Medicine Consults in the Emergency Department: A Quality Improvement Initiative

Introduction: Emergency department (ED) wait time is an important health system quality indicator. Prolonged consult to decision time (CTDT), the time it takes to reach a disposition decision after receiving a specialty consultation request, can contribute to increased overall length of stay in the ED. Objective: To identify delays in the consultation process for general internal medicine (GIM) and trial interventions to reduce CTDT. Methods: The study was conducted at a large tertiary teaching hospital with GIM inpatient wards at two campuses. Four interventions were trialed over sequential Plan-Do-Study-Act cycles: (1) process mapping, (2) resident education sessions, (3) audit and feedback of CTDT, and (4) adding a swing shift during peak consult volume. Measurements: The primary outcome measures were mean CTDT for patients admitted to GIM and the proportion of admitted patients with CTDT of less than 3 hours. Results: Mean CTDT decreased from 4.61 hours before intervention to 4.18 hours after intervention (p< .0001). The proportion of GIM patients with CTDT less than 3 hours increased from 25% to 33% (p< .0001). Conclusions: The interventions trialed led to a sustained reduction in CTDT over a 12-month period and demonstrated the effectiveness of education in influencing physician performance.