Date of Award

Winter 2017

Document type


Degree Name

Masters theses/dissertations - taught courses

First Supervisor

Dr. Pauline Joyce


Quality Improvement, Accident and Emergency Department, Waiting times


Emergency department overcrowding is a public health problem and results in long waiting times and delays in critical treatment for patients. Moreover it has been associated with a number of negative clinical outcomes such as increased complication rates and mortality. Using the DMAIC (define, measure, analyse, improve and control) model for quality improvement (QI), this dissertation investigated the long patient waiting times experienced in a private emergency department in Dublin West. Applying a variety of QI tools, including a fishbone diagram, stakeholder analysis, process flow maps and data collection the root cause of the long patient wait times was identified. The results highlighted that 14% of patients were waiting over 4 hours from triage to see the consultant and 51% of patients were waiting over four hours from triage to discharge or admission. In May 2017 the Irish government announced in the Sláintecare document that it would be implementing the 4 Hour rule (no patient should be waiting over 4 hours from triage to discharge or admission) in Irish emergency departments over the next ten years. With the new guideline in mind, the QI plan focused on improving wait times for patients waiting over 4 hours from triage to see the consultant. Factors that contributed to delayed patient waiting times in that cohort of patients were analysed; the addition of a Physician Associate or Advanced Nurse Practitioner alongside the implementation of a fast track system to treat minor cases was proposed.

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 4.0 License.

File Size

3.8 MB


A thesis submitted in partial fulfilment of the requirements for the degree of MSc in Physician Associate Studies to the Royal College of Surgeons in Ireland in 2017