Quality of care and emergency department throughput during the COVID-19 pandemic in a community health system

Abstract

Objective: This retrospective study explores the strategic plan formulated by AHMC Health System in California, USA, to sustain and improve quality of care and emergency department (ED) efficiency during the COVID-19 pandemic. It also analyzes the plan’s outcomes. ----Background:==== The COVID-19 pandemic has posed challenges for both individuals and healthcare industries alike, impacting decision-making and access to care. AHMC faced staff and resource shortages, patient reluctance, and difficulties adapting to rapidly evolving public health guidelines. These challenges highlighted the critical need for effective plans to maintain or improve healthcare quality and ED performance.
Methods: AHMC adopted a comprehensive three-layer strategic plan in 2020. The first layer, “Pandemic Response,” focused on leadership, staff training and education, infection control, new treatments, and employee vaccination rates. The second layer, “ED Throughput,” set objectives for metrics such as door-to-doctor (door-to-doc) time, ancillary turnaround time (TAT), ED length of stay (LOS), and the left-without-being-seen (LWBS) rates. Progress was monitored through monthly improvement meetings. The third layer, “Quality Excellence,” tracked improvements in COVID-adapted objectives on quality initiatives, based on CMS Quality Star Ratings, Leapfrog Hospital Safety Grades, and Yelp review scores.
Results: By 2023, the three-layer strategic plan had led to many improvements in the quality of care and ED efficiency. AHMC identified 22,287 positive COVID-19 cases, expanded its ventilator inventory by 50%, and enhanced patient outcomes by applying updated treatments. Additionally, AHMC saw a 3% reduction in ED wait times and sustained its overall patient satisfaction rates, CMS Quality Star Rating, and Leapfrog Hospital Safety Grade scores.
Conclusions: AHMC’s three-layer strategic plan showed effectiveness in maintaining quality of care and ED efficiency during the COVID-19 pandemic. By focusing on “Pandemic Response,” “ED Throughput,” and “Quality Excellence,” AHMC was able to adapt to the rapidly evolving public health guidelines, expand its capacity to treat COVID-19 patients and sustain its overall patient safety, satisfaction, and quality ratings. The implementation of this plan highlights the importance of proactive and comprehensive strategies in managing healthcare crises.

Keywords

Emergency department / COVID-19 / Quality of care / Emergency department throughput / Three-layer strategic plan

ACKNOWLEDGEMENTS

The authors would like to thank all AHMC facilities and staff involved with the research and writing of this document and would like to extend a special thanks to Dr. Nick Kwan, Dr. William Huang, Erin Hancock, Nicole Chorvat, Chia-Huei Huang, Jessica Toy, Peng-An Chen, Xiao-Cih Wang, and Chen-Hao Lee.

AUTHORS CONTRIBUTIONS

Wen-Ta Chiu: Conceptualization, methodology, validation, writing, supervision; Wan-Yi Lin: Conceptualization, formal analysis, writing, visualization, project administration; Yu- Tien Lin: Conceptualization, writing, visualization, project administration; Chia-Hsing Yeh: Conceptualization, writing, visualization; Kaveh Aflakian, Pei-Chen Pan, Chien-Yu Liu, Han-Kuan Bai: Investigation, validation, writing; Stanley Toy, John Chon, Steve Giordano, Victor Lange, Suyen Wu, Jonathan Wu: Conceptualization, methodology, validation, supervision.

ETHICAL STATEMENT

Informed patient consent was not required because no patient clinical or identity data was collected, and no patient interventions were completed during the course of study. Therefore ethical review board approval was not required and waived.

FUNDING

This work has no external financial support.

CONFLICTS OF INTEREST DISCLOSURE

The author declares that there is no conflicts of interest.

ETHICS APPROVAL

The Publication Ethics Committee of the Sciedu Press. The journal’s policies adhere to the Core Practices established by the Committee on Publication Ethics (COPE). PROVENANCE AND PEER REVIEW Not commissioned; externally double-blind peer reviewed.

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

DATA SHARING STATEMENT

No additional data are available.

OPEN ACCESS

This is an open-access article distributed under the terms and conditions of the Creative Commons Attribution license (http://creativecommons.org/licenses/by/4.0/).

COPYRIGHTS

Copyright for this article is retained by the author(s), with first publication rights granted to the journal.

CONFLICTS OF INTEREST DISCLOSURE

The authors declare they have no conflicts of interest.

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