R6 HealthAnalytics 1 2

Journal of Infection and Public Health (2016) 9, 757—765
Utilizing health analytics in improving

the performance of healthcare services:
A case study on a tertiary care hospital
Mohamed Khalifa ∗, Ibrahim Zabani
King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia
Received 24 June 2016 ; received in revised form 24 July 2016; accepted 31 August 2016
KEYWORDS Summary Among the most common and chronic problems in the healthcare sys-
Health analytics; tem worldwide is the crowding of emergency rooms (ER); leading to many serious
Performance; complications. King Faisal Specialist Hospital and Research Center utilized health
Improvement; analytics methods to identify areas of deficiency and suggest potential improve-
Healthcare services ments to ER performance. The project implemented solutions and monitored two
indicators; ER length of stay (LOS), reflecting efficiency, and percentage of patients
leaving without treatment, reflecting effectiveness of the ER. A retrospective anal-
ysis of 26,948 ER encounters in 2014 was done in January 2015. Analytics techniques
were used to suggest process redesign based on results. Two recommendations were
implemented; a Fast-Track for lower acuity ER patients and an internal waiting area,
for those patients who can stay vertical and spare an ER bed. 32.8% of ER patients
had lower acuity levels and less than 0.5% of them were admitted to the hospi-
tal. After implementing the two solutions, the total ER LOS was reduced from 20 h
in 2014 to less than 12 h in 2016; 40% improvement. The percentages of patients
left without being seen stayed around 3.5%, while the percentages of patients left
before complete treatment was significantly reduced from 13.5% in 2014 to 5.5%
in 2016. Consequently, the total percentage of patients left without treatment was
reduced from 17% in 2014 to 9% in 2016, with 50% improvement. All other factors
were the same, including numbers of ER visits, Patient Acuity Level, working staff,
working hours, and the count of ER beds. Health analytics methods can be used
to identify areas of deficiency, potential improvements, and recommend effective
∗ Corresponding author.
E-mail addresses: [email protected] (M. Khalifa), [email protected] (I. Zabani).
http://dx.doi.org/10.1016/j.jiph.2016.08.016
1876-0341/© 2016 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Limited. All rights reserved.
758 M. Khalifa, I. Zabani
solutions to positively enhance ER performance. More solutions should be examined

such as team triaging, patients palmar scanning, and placing a physician in triage.
Additionally, more indicators should be monitored, such as the effectiveness of ER
treatment—–including the rates of revisits.
© 2016 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier
Limited. All rights reserved.
ER length of stay (LOS) divided this key perfor-

Introduction mance indicator into three intervals; waiting time;
which is the interval from patient’s arrival to the
Healthcare organizations worldwide are interested ER until he or she is seen by an ER physician, treat-
in achieving better quality and performance; it ment time; from starting the examination by the
is important to define healthcare performance ER physician until a decision is made, whether to
and identify quality improvement dimensions and admit the patient to the hospital or to discharge
methods. Many studies discuss how healthcare per- them home, and boarding time; from making the
formance improvement encompasses the combined decision of admission for some patients until they
and continuous efforts of all healthcare stakehold- are physically moved to an inpatient hospital bed
ers; healthcare professionals, patients and their [6].
families, researchers, payers, planners, and edu- Using these conceptual models we can work on
cators, to make the changes that will lead to developing strategies and solutions to decrease ER
better patient outcomes, better system perfor- crowding and improve performance. The problem
mance and better professional development [1]. of inadequate staffing, due to lack of physicians
Many criteria and measurable attributes can define or nurses, low ER physicians and nurses’ produc-
healthcare performance and quality, such as safety, tivity, low efficiency of ER staff, and shortages of
effectiveness, efficiency, availability, accessibility, treatment areas are commonly studied throughput
timeliness, and equity. This is why healthcare pro- factors that may cause ER crowding and prolonged
fessionals and organizations must take into account LOS [7]. Lower staffing levels or productivity of
patient preferences as well as social preferences in physicians and triage nurses predisposed patients to
assessing and assuring quality [2]. Among the most wait longer for care [8]. Competency of attending
common and chronic problems in the healthcare physicians in ER, in terms of skills and efficiency,
system worldwide is the crowding of the emergency and lack of, or slow, responsiveness of ER nurses
room; leading to many serious consequences and has been associated, in many studies, with patients
complications. This problem needs to be addressed leaving without being seen or leaving before com-
with more innovative and unconventional solutions plete treatment. The use and/or delays of the
[3]. ancillary services, including lab, radiology and
other procedures, usually prolong the ER length of
Emergency room crowding stay [9].
This study describes in details the processes
Crowding in emergency rooms (ER) and the implemented in the ER performance improvement
impaired performance of this essential service at King Faisal Specialist Hospital and Research
has become a major concern for both healthcare Center, Jeddah, Saudi Arabia. The executive man-
professionals and researchers. ER impaired perfor- agement of the medical and clinical affairs of the
mance is becoming a major barrier to receiving hospital decided to utilize health analytics methods
effective, efficient, and timely emergency care. to identify areas of deficiency and suggest potential
Patients who present to the ER face long waiting improvements then implement solutions and finally
times to be treated and those under treatment monitor ER using two main key performance indi-
might even face longer treatment times until they cators; the ER LOS for ER patients, reflecting the
are admitted to the hospital or discharged home efficiency of performance [10], and the percent-
[4]. Some researchers analyzed ER crowding and age of patients leaving the ER without treatment,
classified its related factors into three interdepen- including both patients who left without being seen
dent components: input factors, throughput factors and those who left before complete treatment,
and output factors [5]. Other researchers studying reflecting the effectiveness of ER performance [11].

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Journal of Infection and Public Health (2016) 9, 757—765

Utilizing health analytics in improving

solutions to positively enhance ER performance. More solutions should be examined

ER length of stay (LOS) divided this key perfor-

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