Accepted for/Published in: JMIR Human Factors
Date Submitted: May 3, 2024
Date Accepted: Sep 23, 2024
A work systems analysis of emergency nurse patient flow management using the Systems Engineering Initiative for Patient Safety (SEIPS) model: Applying findings from a grounded theory study
ABSTRACT
Background:
Emergency nurses actively manage the flow of patients through emergency departments. Patient flow management is complex, cognitively demanding work that shapes the timeliness, efficiency, and safety of patient care. Research exploring nursing patient flow management is limited. A comprehensive analysis of emergency nursing work systems is needed to improve patient flow work processes.
Objective:
The purpose of this paper is to describe the work system factors that impact emergency nurse patient flow management using the System Engineering Initiative for Patient Safety (SEIPS) model.
Methods:
This study used grounded theory methodologies. Data was collected through multiple rounds of focus groups and interviews with 24 emergency nurse participants and sixty-four hours of participant observation across four emergency departments. Data were analyzed using coding, constant comparative analysis, and memo-writing. Emergent themes were organized according to the first component of the SEIPS model, the work system.
Results:
Patient flow management is impacted by diverse factors, including personal nursing characteristics, tools and technology, external factors, and the emergency department’s physical and socio-organizational environment. Participants raised concerns about available technology’s functionality, usability, and accessibility; departmental capacity and layout; resources levels across the healthcare system; and interdepartmental teamwork. Other noteworthy findings include obscurity and variability across departments’ staff roles titles, functions, and norms; the degree of provider involvement in patient flow management decisions; and management’s enforcement of timing metrics.
Conclusions:
There are significant barriers to the work of emergency patient flow management. More research is needed to measure the impact of these human factors on patient flow outcomes. Collaboration between healthcare administrators, human factors engineers, and nurses is needed to improve emergency nurse work systems. Clinical Trial: N/A
Citation
Request queued. Please wait while the file is being generated. It may take some time.
Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.