Objectives: In emergency departments (EDs), overcrowding, workload complexity, and cost containment represent current operational problems. In this retrospective observational study, we analyzed the effects of a professional quality management (QM) system on patient flow, diagnostic validity, and hospital costs.
Materials and methods: In 2005/2006, the main ED at the University Medical Center Goettingen was reorganized. A professional QM system according to DIN EN ISO 9001:2008 was introduced in 2008. In a retrospective observational study, we compared the number of cases, the spectrum of clinical diagnoses, the validity of diagnoses, and hospital costs in the ED before (2005) and 2 years after the introduction of the QM system (2010).
Results: In the ED at the University Medical Center Goettingen, the number of cases increased by 22.7% between 2005 and 2010. After the introduction of the QM system, a significant reduction in patients' length of stay within the ED was achieved (P<0.001). Furthermore, the rate of diagnostic errors for patients assigned for admission within the ED could be reduced significantly (P=0.002). A reduction of patient-related hospital costs of 8.9% was achieved by restriction of diagnostic tests according to standard operating procedures for each emergency diagnosis.
Conclusion: The introduction of a professional QM system in EDs improves patient flow as well as quality of medical care and results in a significant reduction in hospital costs. Further analyses should evaluate the effects of QM on quality indicators in a prospective multicenter study. Validation of results has to be performed in a dynamic model for process simulation.