Building Hospital Management Capacity to Improve Patient Flow for Cardiac Catheterization at a Cardiovascular Hospital in Egypt

Background: Quality improvement (QI) has been shown to be effective in improving hospital care in high-income countries, but evidence of its use in low-and middle-income countries has been limited to date. The impact of a QI intervention to reduce patient waiting time and overcrowding for cardiac catheterization-the subset of procedures associated with the most severe bottlenecks in patient flow at the National Heart Institute in Cairo-was investigated. Methods: A pre-post intervention study was conducted to examine the impact of a new scheduling system on patient waiting time and overcrowdedness for cardiac catheterization. The sample consisted of 628 consecutive patients in the pre-intervention period (July-August 2009) and 1,607 in the postintervention period (September-November 2010). Results: The intervention was associated with significant reductions in waiting time and patient crowdedness. On average, total patient waiting time from arrival to beginning the catheterization procedure decreased from 208 minutes to 180 minutes (13% decrease, p<.001). Time between arrival at registration and admission to inpatient ward unit decreased from 33 minutes to 24 minutes (27% decrease, p<.001). Patient waiting time immediately prior to the catheterization laboratory procedure decreased from 79 minutes to 58 minutes (27% decrease, p<.001). The percentage of patients arriving between 7: 00 A.M. and 9: 00 A.M. decreased from 88% to 44% (50% decrease, p<.001), reducing patient crowding. Conclusion: With little financial investment, the patient scheduling system significantly reduced waiting time and crowdedness in a resource-limited setting. The capacity-building effort enabled the hospital to sustain the scheduling system and data collection after the Egyptian revolution and departure of the mentoring team in January 2011.