| Emergency Department (ED) crowding is a dangerous phenomenon impacting the responsiveness of the nation's EDs and has commanded the attention of numerous public and private invested industry participants. The Theory of Constraints (TOC) is one performance improvement methodology specifically endorsed for to its ability to identify the most worthwhile point of intervention, or constraint, in a productive process. The purpose of this within subjects quasi-experimental quantitative study was to determine the impact of using TOC's mechanisms to implement an intervention designed to address identified constraints in the current ED admission process at a small California hospital. This was done by replacing the historic verbal nursing patient handoff report with a pilot version of an automated report as an independent variable to alter the ED to inpatient admission handoffs of 46 patients.;The chosen dependent variables, describing the ED's overall performance, did not capture a significant outcome due to their high variability. Further inquiry into the data found that the last portion of the patient's stay in the ED, when the tool was specifically utilized, was significantly shortened by 22 minutes (p = .001). After the interventional period, nurses that had used the intervention were surveyed and widely stated approval for the tool due to its efficiency and also the improved quality of patient information that was communicated compared to the historic process. This research found that TOC can be beneficial to guide ED performance improvement, but constraint identification must be precise. In spite of not addressing the subject ED's greatest specific constraint, the automation of a nursing handoff report is supported in this research for the improved efficiency and quality of communication it facilitates. |
