Venisha Naina Dsouza

A TIME AND MOTION STUDY IN THE
EMERGENCY DEPARTMENT OF FATHER MULLER

MEDICAL COLLEGE HOSPITAL
BY
Ms. VENISHA NAINA D’SOUZA
A PROJECT SUBMITTED TO
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
KARNATAKA
IN PARTIAL FULFILMENT
OF THE REQUIREMENT FOR THE AWARD OF THE DEGREE OF
MASTERS IN HOSPITAL ADMINISTRATION
UNDER THE GUIDANCE OF
Mrs. SONIA E D’SOUZA, LECTURER
DEPARTMENT OF HOSPITAL ADMINISTRATION

FATHER MULLER MEDICAL COLLEGE
MANGALORE
2009 – 2011
Rajiv Gandhi University of Health Sciences,
Karnataka, Bangalore
DECLARATION BY THE CANDIDATE
I, Ms. VENISHA NAINA D’SOUZA, hereby declare that this project entitled “A TIME
AND MOTION STUDY IN THE EMERGENCY DEPARTMENT OF FATHER
MULLER MEDICAL COLLEGE HOSPITAL” is a bonafide and genuine research
work carried out by me under the guidance and supervision of Mrs. SONIA E D’SOUZA,
LECTURER, Department of Hospital Administration, Father Muller Medical College,
Mangalore.
I also declare that this project has not been formed the basis for the award of any degree or
diploma of any other university.
Date: Ms. VENISHA NAINA D’SOUZA
Place: Mangalore
CERTIFICATE BY THE GUIDE
This is to certify that the project entitled “A TIME AND MOTION STUDY IN THE
EMERGENCY DEPARTMENT OF FATHER MULLER MEDICAL COLLEGE
HOSPITAL” is a bonafide research work done by Ms. VENISHA NAINA D’SOUZA in
partial fulfilment of the requirement for the degree of Master in Hospital Administration
Father Muller Medical College, Mangalore, is a record of research work carried out by him
under my direct guidance and supervision.. This project either fully or partially has not
been submitted elsewhere for any other degree or diploma.
Date MRS. SONIA E D’SOUZA

LECTURER
Place: Mangalore
DEPARTMENT OF HOSPITAL ADMINISTRATION
ENDORSEMENT BY THE HEAD OF THE
INSTITUTION
This is to certify that this project entitled “A TIME AND MOTION STUDY IN THE
EMERGENCY DEPARTMENT OF FATHER MULLER MEDICAL COLLEGE
HOSPITAL” is a bonafide research work done by VENISHA NAINA D’SOUZA under
the guidance of Mrs. SONIA E D’SOUZA, LECTURER, Department of Hospital
Administration, Father Muller Medical College, Mangalore. This project is submitted to
the Rajiv Gandhi University of Health Sciences regulations for the award of Master in
Hospital Administration.
DR. JAYAPRAKASH ALVA, M.D. DR. JAYAPRAKASH ALVA, M.D

HEAD OF DEPARTMENT DEAN
HOSPITAL ADMINISTRATION FATHER MULLER MEDICAL
COLLEGE
Date: Date:
Place: Mangalore Place: Mangalore

COPYRIGHT
DECLARATION BY THE CANDIDATE
I, VENISHA NAINA D’SOUZA hereby declare that the Rajiv Gandhi University of
Health Sciences, Karnataka shall have the rights to preserve, use and disseminate this
project in print or electronic format for academic / research purpose.
VENISHA NAINA D’SOUZA

Date:
Place: Mangalore
© Rajiv Gandhi University of Health Sciences, Karnataka

ACKNOWLEDGEMENT
After having this project report, I thank almighty God for the Grace and Love
showered on me during the course of preparing the project report.
Firstly, I would like to like to acknowledge the support and encouragement

rendered to me by the Dr. Jaya Prakash Alva, Dean Father Muller Medical College
Hospital for having given me an opportunity to do my dissertation work as part of my
studies.
I am grateful to Rev. Fr. Patrick Rodrigues, The Director of Father Muller

Charitable Institutions, Rev. Fr. Richard Coelho, Administrator of Father Muller Medical
College Hospital and Rev. Fr. Denis D’Sa, Administrator of Father Muller Medical
College for their loving support and guidance.
My heart filled gratitude to my guide Mrs. Sonia E D’Souza, Lecturer,

Department of Hospital Administration, Mangalore for having supported me throughout
my project.
I avail this opportunity to express deep sense of gratitude to Mrs. Sucharita

Suresh our statistician for her constant support and guidance, Fr. Reginald Pinto, the
course coordinator and Mrs. Sweta D’Cunha for their support and guidance.
I wish to express my heartfelt thanks to Sister In-charge of emergency department

and all other Staff for their willingness and co-operation that made this study a reality.
I would like to thank my Parents from the bottom of my heart for their moral
support and encouragement.
Finally, I would like to express my appreciation and gratitude to all my Friends

who have helped me in every way in doing this project.
Thank you one and all
Venisha Naina D’Souza

ABSTRACT
Background:
The Emergency Department process is critical for any hospital. Short waiting times
and a positive experience represent important drivers of patient satisfaction. Meanwhile,
inefficient processes can result in lost revenues and poor community image, not to mention
concern over patient safety. Since Emergency Department (ED) is frequently a patient’s
first experience with the hospital, improving the efficiencies is paramount to both customer
satisfaction and hospital’s bottom line.
Time and motion study is used to observe sequential movements involved and to
assess the time for each movement in the department to be studied. This study helps to
know the unnecessary and delayed movements in the department so as that with this
knowledge the management will be able to take adequate measures to improve the
functioning of the department.
Objectives:
1. To observe the various sequential movements in emergency department.
2. To assess the time taken for each sequential movement.
Methods:
The Research approach adopted in this study is Descriptive Method. This includes
collection of data using observational checklist from patients visiting emergency
department.
Results:
The time and motion study helped to determine various sequential movements and
time taken for each movement in the ED through checklist when compared with the
international benchmark the time interval was found to be within the standards.
Conclusion:
This understanding of the sequential movements involved and the time required for each
movement in emergency services helps to identify and eliminate unnecessary movements
and benchmark the time and thus to provide efficient and effective patient care in ED.
Keywords:
Emergency department, time interval, sequential movements
LIST OF ABBREVIATIONS USED
DMO- Deputy Medical Officer
ED- Emergency department
M- Medical
O-Orthopaedics
S-Surgical
T-Trauma
CONTENTS
CHAPTER NO TITLE PAGE NO
INTRODUCTION AND REVIEW OF 1

I LITERATURE
13
II INDUSTRY PROFILE
15
III COMPANY PROFILE
OBJECTIVES AND RESEARCH 18

IV METHODOLOGY
21
V DATA ANALYSIS
INTERPRETATION OF DATA 42
VI
FINDINGS AND SUGGESTIONS 46

VII
VIII CONCLUSION 51
52
IX BIBLIOGRAPHY
55
X ANNEXURE
LIST OF TABLES
SL.NO TABLES PAGES

1 Distribution according to gender of the patients 21
2 Distribution according to age of patients 22
3 Distribution according to marital status of patients 23
4 Distribution according to transfer of patients 24
Medical unit: Total time taken between the arrival of the patient and
5(a) 25
completion of evaluation
5(b) Total time taken between ordering and completion of investigation 26
Total time taken between patient arrival to admission to
5(c) 27
ward/OT/ICU or getting discharged from emergency department
Surgical unit: Total time taken between the arrival of the patient and
6(a) 28
6(c) 30
Orthopaedic unit: Total time taken between the arrival of the patient
7(a) 31
and completion of evaluation

7(c) 33
Trauma unit: Total time taken between the arrival of the patient and
8(a) 34

8(c) 36
Average time taken between the arrival of the patient and completion
9(a) 37
of evaluation
9(b) Average time taken between ordering and completion of investigation 38
Average time taken between patient arrival to admission to
9(c) 39
10 Average time taken between patient arrival and discharge 40

LIST OF FIGURES
SL.NO FIGURES PAGES
1 Gender wise distribution of patients 21
2 Age wise distribuiton of patients 22
Marital status wise distribution of

3 23
patients
Patient transfer wise distribution 24

4
INTRODUCTION
INRODUCTION
The Emergency Department process is critical for any hospital. Short waiting times
and a positive experience represent important drivers of patient satisfaction. Meanwhile,
inefficient processes can result in lost revenues and poor community image, not to mention
concern over patient safety. Since Emergency Department (ED) is frequently a patient’s
first experience with the hospital, improving the efficiencies is paramount to both customer
satisfaction and hospital’s bottom line.
Time and motion study is used to observe sequential movements involved and to
assess the time for each movement in the department to be studied. This study helps to
know the unnecessary and delayed movements in the department so as that with this
knowledge the management will be able to take adequate measures to improve the
functioning of the department.
Father Muller Medical College Hospital is 129 years historical hospital with a well
established emergency department. There is a frequent patients flow to avail emergency
services 24 hrs round the clock. This time and motion study is done to assess the sequential
activities of the department and to know the time required for each activities so that that
the management can undertake certain measures to improve the efficiency of the service
rendered by the department to the patients.
Time and motion study are two broad groups of techniques constituting the field of
work study. Work study may be defines as systematic examination of methods of carrying
on activities so as to improve the effective use of manpower and equipment and to set up
standards of performance for the activities being performed. Motion study, also called
method study is the systematic recording and critical examination of the ways of doing
things to make improvements. It involves investigation of existing or alternate proposed
methods of work and improving them. Time study, also called work measurement, is
application of systematic techniques to establishing time standards for carrying out
specified jobs. It estimates how long a job should take and the manpower and equipment
requirements for a given method.
1
The advantages of time and motion study in hospital industry are same as that in any other
industry. These include the following.
1. To improve the methods or procedures adopted in performance of various jobs.
2. Improving the layout of the facility. For example in a hospital it may include lay out for
facilities such as overall hospital layout, lay out of beds in a ward, layout of support
facilities such as kitchen and reception area.
3. To improve utilization of resources. For hospitals will include resources like hospital staff.
Operation theatres, hospital equipments, and diagnostic equipments.
4. To reduce human effort by proper design of processes. In hospitals this can also include
reducing the efforts patients need to make for different actions involved in their treatment
as well as for their routine hospital treatment and care.
5. To develop suitable working conditions. In hospitals this would include design to suit the
requirements of hospital staff as well as the patients.
There are really no advantages of the time and motion study directly. However, we
can think of some limitations. For example, the time and motion studies focus on the
productive resources like the hospital staff and equipment. Traditionally these techniques
do not focus much on improving service. However in hospital the level of service is very
important. This disadvantage can easily be overcome by treating patients as important
resources with specialized requirements. Similarly in some jobs, such as operating on a
patient, the speed of completing the job is much more important than achieving efficiency.
This limitation can also be overcome by appropriately changing the focus of work study
and design.
2
LITERATURE
REVIEWS
REVIEW OF LITERATURE
Medical emergency:
A medical emergency is the sudden and acute onset of a symptom or symptoms,
including severe pain that would lead a reasonable, prudent layperson to believe: A health
condition exists requiring immediate medical attention. Failure to provide medical
attention would result in serious impairment to bodily functions or serious dysfunction of
bodily organs, or would place the person's health in serious jeopardy [1].
According to Marvin D Feit et al [2] the American college of emergency physician

has defined a medical emergency as:
 Any condition resulting in admission of the patient to a hospital or nursing home
within 24 hours.
 Evaluation or repair of acute(less than 72 hours) trauma
 Relief of acute or severe pain
 Investigation or relief of acute infection
 Protection of public health
 Obstetrical crises and/or labour
 Haemorrhage or treatment of haemorrhage
 Shock or impending shock
 Any sudden and / or serious symptom(s) which might indicate a condition which
constitutes a threat to the patient’s physical or psychological well-being requiring
immediate medical attention to prevent possible deterioration, disability, or death.
Kinds of medical emergencies:

[3]
Dr. Vasanth Kumar (1990) in his article “The book health of the
metropolitans:-Bangalore stated the types of emergencies as
 Accidents
 Burns
 Disaster- floods, air crafts, railway accidents, earthquake
 Emergencies on large scale-rioting, civil disorders, mass poisoning.
 Medical emergencies –Myocardial inspection, Cerbrovascular accidents
 Surgical emergencies
 Obstetrical emergencies
 Military operations
3
Emergency department:
According to S.M Jha [4] Emergency department is that location or department in a
hospital or other institutional facility that is focused on caring for acutely ill or injured
patients. Physicians are specially trained and certified in emergency care and it has grown
to be an entire department.
[5]
According to Francis C.M. & De Souza Mario C the Casualty services provide
immediate, emergency diagnostic and therapeutic care to patients with
a. Injuries by accidents, or
b. Sudden attacks of illness or exacerbation of the disease.
The treatment provided must be immediate and competent. If the condition is serious, it
can make all the differences life and death. If the treatment is delayed or is not competent,
the person can be out of job for a long time. Prolonged and expensive rehabilitation may be
necessary to put the person back on the job. Hence a casualty service must avoid delay in
attending to the management.
[6]
I. Donald Snook defines Emergency department is that department or unit of a
hospital organized to provide medical services necessary to sustain life or to prevent
critical consequences. This area sometimes provides non-urgent, walk-in care. The
department is usually staffed 24hours per day by physician and nurses.
[7]
S.L Goel, R.Kumar says the casualty department provides round- the- clock,
immediate diagnosis and treatment for illness of an urgent nature and injuries from
accidents. Simple cases after administering preliminary treatment are discharge with
instructions to attend OPD as a follow –up measure. Cases of serious nature are admitted
in emergency wards to provide immediate medical care. Such patients are either discharge
after 2-3 days or are transferred to permanent in-patient wards. Emergency service is
acquiring increasing importance due to modern problems arising out of urbanization and
mechanization. The best services must be provided to the patients in the emergency ward
as the patients and their relatives are under emotional strain and surcharged with suspense
and calamity that has come up suddenly. Such an approach would alleviate a large part of
sufferings born out of fear and suspicion of the unknown.
4
Importance of emergency department:
The emergency department (ED) is an important source of revenue for hospitals.
Patient satisfaction is necessary to any effort to optimize revenues. If patients fail to move
efficiently through the ED, their perception of the experience might be negative. The ED
represents a financial lifeline for many hospitals and arguably is the top revenue
contributor for many facilities. The ED accounts for 30 to 45 percent of admissions and
about 5 percent of total revenue in most hospitals. The ED also represents 20 to 30 percent
of a hospital's laboratory and radiology volume and revenue. The first impression of the
hospital for many patients and their family members is formed in the ED, and first
impressions are lasting. Service delivery and patient satisfaction are directly related to
realizing the economic benefits of the ED. Hospitals; therefore, need to ensure that ED
patients perceive their hospital experience as positive. ED patients often measure quality
on the basis of factors unrelated to the staff's clinical expertise. Instead, ED patients ask
themselves the following quality-related questions:
* How long did I wait?

* Was I treated with dignity?
* Was I comfortable?
* Was the facility attractive?
* Were procedures explained? [8]
Time and motion study:

Time and motion study, or motion and time study, is a basic set of tools used by
industrial engineers to increase operational efficiency through work simplification and the
setting of standards, usually in combination with a wage-incentive system designed to
increase worker motivation. Originally developed to drive productivity improvement in
manufacturing plants, motion and time study is also now used in service industries [9].
[10]
According to Fredrick Winslow Taylor “Time study is the technique of
observing and recording the time required to do each element of an industrial operation.
Through time study, the precise time required for each element of a man’s work is
determined. It helps in fixing the standard time required to do a particular job”
“Motion study is the study of the movements of an operator or a machine. Its
purpose is to eliminate useless motions and find out the best method of doing a particular
job”.
5
Importance of time and motion study
A 5-Year Time Study Analysis of ED Patient Care Efficiency was conducted by
Kyriacou DN et.al [11] with the aims to calculate the main ED patient care time intervals to
identify areas of inefficiency, and to quantitatively assess the effects of administrative
interventions aimed at improving efficiency, Showed that Time studies are an effective
method of identifying areas of patient care delay and thereby in ED, targeted
administrative interventions apparently reduced the total ED LOS(length of stay) and
improved overall efficiency.
A Hospital Time and Motion Study was conducted by Ann Hendrich et.al [12] in a
EDidentified three subcategories accounted for most of nursing practice time as
documentation (35.3%; 147.5 minutes), medication administration (17.2%; 72 minutes),
and care coordination (20.6%; 86 minutes). Also patient care activities accounted for
19.3% (81 minutes) of nursing practice time, and only 7.2% (31 minutes) of nursing
practice time was considered to be used for patient assessment and reading of vital signs.
Thus the study recommended that Changes in technology, work processes, and unit
organization and design may allow for substantial improvements in the use of nurses’ time
and the safe delivery of care.
Different areas of delay in ED:

A continuous observation time study was used to track 1,568 patients through
various stages of ED care in order to identify sources of delay. Patients initially were
assigned to one of four categories of decreasing acuity. The study showed that Urinalyses,
procedures, radiographs, and blood tests had an increasing impact on treatment times (45
minutes, 63 minutes, 65 minutes, and 126 minutes, respectively, compared to 31 minutes
with no tests or procedures). Patients of increasing acuity moved more quickly, but with a
longer evaluation and treatment time [13].
A study was done to determine the impact of delays to admission from the
Emergency Department (ED) on inpatient length of stay (LOS), and IP cost at a tertiary
care teaching hospital with two ED sites in which the mode of disposition was admission
to ICU, surgery or inpatient wards. The primary outcomes were IP LOS, and total IP cost.
Approximately 11.6% (n = 1558) of admitted patients experienced admission delay. In
multivariate analysis we found that admission delay was associated with 12.4% longer IP
LOS (95% CI 6.6% - 18.5%) and 11.0% greater total IP cost (6.0% - 16.4%). We
6
estimated the cumulative impact of delay on all delayed patients as an additional 2,183
inpatient days and an increase in IP cost of $2,109,173 at the study institution. Delays to
admission from the ED are associated with increased IP LOS and IP cost. Improving
patient flow through the ED may reduce hospital costs and improve quality of care. There
may be a business case for investments to reduce ED admission delays [14].
For Identification of Root Causes for Emergency Diagnostic Imaging Delays at Three
Canadian Hospitals , modified time-in-motion study was conducted at 3 urban emergency
departments Analysis of 2297 cases revealed the mean turnaround time for one site was 50
minutes and significantly greater (P < .05) than the means of the other 2 sites
(approximately 33 and 37 minutes, respectively). The identified 3 root causes of delay (1)
processing of radiograph request order by registered nurse; (2) transport times; and (3)
radiology suite location. It was found that both radiology and ED staffing considerations
and workload contribute to delays in turnaround times of diagnostic imaging investigations
[15]
.
[16]
Punnell .L (1995) conducted a survey of 390 hospitals across the United States
according to this extended waiting times in leads to general overcrowding that results in
increased nursing care time and client dissatisfaction. Several successful strategies for
reducing both waiting time and turnaround time are suggested.
The emergency department and managed care hand book specifies that Patients come
to the ED for immediate attention for medical problem and naturally get tired of waiting
when they have to:
 wait for the triage nurse, then
 wait for registration, the
 wait to go back to an examination room, then
 wait for the treatment nurse, then
 wait for the doctor, the
 wait for the doctor to finish the physical examination and history, then
 wait for the doctor to decide what diagnosis to order, then
 wait for the nurse to draw the blood, then
 wait for the blood test result, then
 wait for the X-ray film to be taken, then
 wait for the X-ray result, then
7
 wait for the doctor to analyze the blood and x-ray results, then
 wait for the primary care doctor to call back, then
 wait for the EP to make a diagnosis and a disposition, and finally
 wait for the nurse or an aide to deliver the discharge paperwork
These prolonged waiting time leads to patient dissatisfaction [17].
According to C.M.Francis [17] (1995) all necessary equipment for the management
of all emergencies must be available without delay. Time is of essence.
The common management problems are:-
 prolonged waiting time
 incompetent doctors/ nurses
 staff not trained to handle emergencies
 Communication delay when others doctors are summoned.
[18]
Paine S (1994) made a study to enable to research based on standards to be set in
relation to waiting time. This would be in accordance with the recommendation of the
patients chart (department of health) 1992. The study was undertaken with the cooperation
of the staff of the accident and EDwithin an acute time in the oxford region. Between 1st
January and 31st December 1992 a random sample of 230 casualty cards were drawn and
analyzed. Analysis showed that 90.5% of patients in the sample were assessed by a nurse
at (or) within 10 minutes of arrivals and 83.25% of patients in the sample were seen by
doctors at (or) within 60 minutes of arrival.
A study done in Al-Noor Specialist Hospital, Makkah, Saudi Arabia highlighted the
reasons which contributed to longer stay of patients in Emergency Department (ED) who
were advised admission. The delayed patients were divided into Group A and B, delayed
before and after admission was advised, respectively. Prolonged length of stay (Delay) in
ED was defined as stay longer than 2 hours after patient's arrival in ED until they were
received to wards. Out of total 4876 visits during study period, 355 (7.3%) patients were
admitted, and 238 (67%) were delayed. The mean length of stay of delayed subjects was
256 minutes. Common reason of delay in Group A was multiple consultations with further
investigations 70 (48%) (p<0.001) while file making process was common 40 (43.5%) in
group B (p<0.001).Out of admitted patients 67% were delayed mainly due to late advised
admission with major reason of delay were multiple consultations[20].
8
Sequential movements
Sequential movements are a series of separate movements that are joined together
in a desired sequence to perform a given job. An example of sequential movement might
be the reaching for an object with the left hand, reaching for a tool with the right hand, and
bringing the two together to perform the desired adjustments using the tool [21].
Sequential emergency procedures:

H.M.C Macaulay & R .Llewellyn Davis [22] (1995) – suggested circulation pattern
in accident or emergency unit.
Ambulant patients
Seriously injured
patients
RECEPTION AND WAITING ROOM
EXAMINATION, DIAGNOSIS, TRAETMENT

Resuscitation
(Including X- ray diagnostic facilities)
FURTHER TRAETMENT
(Theatre, plaster room, recovery beds)
TRANSFER
Discharge Mortuary
Out patients In patients General Another hospital

practitioner
9
[23]
Goel S.L, Kumar R (1989) in their book of hospital administration and
management the public accounts committee(1997-98) suggested the procedure as follows:
Reception and enquiry
Registration
Examination
Admission Keeping under examination Dressing
Discharged (d) Restored
Normal health or death
10
Matthew Cooke, Joanne Fisher et.al [24] (2004) – suggested flow diagram as
follows:
11
According to the study conducted on waiting and interaction times for patients in a
developing country accident and ED showed that the A&E could improve patient care
processes by shortening waiting times, especially for laboratory results, triage, and seeing a
doctor, particularly for older medicine patients. The Mean A&E waiting times compared to
international benchmarks [25]
Mean A&E Mean US time or Recommended time

time (min) worthy goal(min) (min)
A&E, accident and emergency; EP, emergency physician; LOS, length of stay; min,
minutes; TAT, turnaround time.
Registration 1.8 >10 5–10
Wait to triage 39.5 – 0
Wait to reach cubicle 92.5 15 10
Wait in cubicle 138.7 15 10
Door to EP 234.1 22 14
Wait before treatment 133.1 60 20–30
Lab TAT 236 60 30–40
x Ray TAT 75.8 60 20–30
Wait after admission 170 45 24
Wait after discharge 15.7 – 15
Total LOS Admitted 486 240+ 120–240
Discharged 357 150 60–90
Overall 377 115 90
12
INDUSTRY
PROFILE
INDUSTRY PROFILE
A hospital is an institution for diagnosing and treating the sick or injured,

housing them during treatment, examining patients, and providing treatment by specialized
staff and equipment even for a longer-term patient stays. The word hospital comes from
the Latin word “hospes”, signifying hospitality. Its historical meaning, until relatively
recent times, was "a place of hospitality".
Worldwide, most hospitals are run on a non-profit basis by governments or

charities .Hospitals may be public (government-owned) or private (profit-making or not-
for-profit). Historically hospitals were often founded and funded by religious orders or
charitable individuals and leaders. But today, hospitals are usually funded by the public
sector, by health organizations (for profit or non-profit), health insurance companies or
charitable trusts and also donations from private limited companies. In India the growing
potential in the healthcare sector is now attracting the private players to invest and it is
found that private sector has major share in hospital industry mainly targeting urban
population.
Some patients go to a hospital just for diagnosis, treatment, or therapy and then
leave ('outpatients') without staying overnight; while others are 'admitted' and stay
overnight or for several days or weeks or months ('inpatients'). Day Care centre where
patient are admitted for one day is Hospitals usually are distinguished from other types of
medical facilities by their ability to admit and care for inpatients whilst the others often are
described as clinics.
The best-known type of hospital is the general hospital, which is set up to deal with
many kinds of disease and injury, and normally has an ED to deal with immediate and
urgent threats to health. In the Specialty hospitals services are limited to a single type of
patient or illness. Types of specialized hospitals include trauma centers, rehabilitation
hospitals, children's hospitals, geriatric hospitals, and hospitals for dealing with specific
medical needs such as psychiatric problems, certain disease categories such as cardiac,
oncology, or orthopedic problems, and so forth .However, general hospitals usually also
have specialized departments, and special hospitals tend to become affiliated with general
hospitals. A teaching hospital combines assistance to patients with teaching to medical
students and nurses and often is linked to a medical school, nursing school or university.
Larger cities may have several hospitals of varying sizes and facilities marked as
13
secondary care, tertiary care, super specialty, day care etc. Some hospitals also have their
own ambulance service.
A hospital may be a single building or a number of buildings on a campus. Many

hospitals with pre- twentieth-century origins began as one building and evolved into
campuses. Some hospitals are affiliated with universities for medical research and the
training of medical personnel such as physicians and nurses.
Hospitals vary widely in the services they offer and therefore, in the departments
they have. They may have acute services such as an ED or specialist trauma centre, burn
unit, surgery, or urgent care. These may then be backed up by more specialist units such as
cardiology or coronary care unit, intensive care unit, neurology, cancer center, and
obstetrics and gynaecology. Some hospitals will have outpatient departments and some
will have chronic treatment units such as behavioural health services, dentistry,
dermatology, psychiatric ward, rehabilitation services, and physical therapy.
Common support units include a dispensary or pharmacy, pathology, and

radiology, and on the non-medical side, there are medical records departments, release of
information departments, Facilities Management, Marketing departments, Housekeeping,
Maintenance, Public Relation offices, Linen and Laundry department, Dietary Services,
and Security departments.
In India hospital industry is booming at a fast rate. Presently Rs 200,000 crore is

the size of the industry slated to clock Rs 300,000 crore by 2012. New hospitals are
mushrooming even in smaller town, adopting new age technology, new models of business
strategy, and new players in the market the healthcare market is growing at a rate of 16%
year on year. Thus it can be said as one the largest service sector in the economy.
14
COMPANY
PROFILE
COMPANY PROFILE
PROFILE OF FATHER MULLER CHARITABLE INSTITUTIONS (FMCI)
Name of the Institution : Father Muller Charitable Institutions

Address : Father Muller Road, Kankanady
Mangalore 575 002
Telephone : 0824-2238000
Website : www.fathermuller.com
Historical Information:
Year in which the Institution

was founded : 1880
Organization which founder
the Institution : Diocese of Mangalore
Chairman of the Institution : Most Rev. Dr Aloysius Paul D’Souza
Bishop of Mangalore
Head of the Institution : Rev. Fr Patrick Rodrigues
Director
No. of employees : 1500
FMCI VISION STATEMENT

To heal and comfort the suffering humanity with compassion and respect; and to be
recognized as a global leader in medical education and research
FMCI MISSION STATEMENT

Mission of the Institution is:
 To be progressive in providing holistic health care services to all.
 To establish and operate hospitals with state-of-the-art facility.
 To create and foster centre’s of excellence in medical education and research.
 As a charitable institution, to be a pioneer in reaching out to the marginalized.
 To be recognized as a Global leader in providing quality patient care, best medical
education and research responsive to society’s needs.
15
The Hospital with 1050 beds has the following Departments:
a) Round the clock Services: Emergency and Trauma Centre
C.T. Scan, Ultra Sound, M.R.I
Blood Bank
Pharmacy
Laboratory Services
Medical Records Department
b) Well organized Out-patient Department of all Specialities
c) Super-Speciality clinics : Cardiology

Cath Lab
Cardio-thoracic Surgery
Oncology
Plastic Surgery
Paediatric Surgery
Urology
Neuro-surgery
Nephrology
Chest and Allergy clinic
Clinical Psychology
De-addiction Centre
Counselling
d) Physical Medicine and Rehabilitation Unit :
Physiotherapy
Speech and Hearing Unit
Occupational Therapy Unit
e) Special Care Units: M. I. C. U.
I. C. C. U.
N. I. C. U.
16
Supportive facilities:
Accounts Department House Keeping Department

Administration Department Linen and Laundry
Billing Section Maintenance
C. S. S. D. Medical Records Department
Central Library Medical Store Medico-Social Work
Computer Section Mortuary and Autopsy room
Counseling Centre Pastoral Care Ministry
Credit/Insurance Office Personnel Department
Departmental Libraries Public Relations
Dietary/Cafeteria and Farm Reception and Enquiry
Establishment Section Rehabilitation Unit
General Stores Security Services
Homoeopathic Pharmaceutical St Joseph Leprosy Hospital
Division Telephone Operator
Hospital Canteen Transport and Ambulance Service
Father Muller General Hospital is a Unit of Father Muller Charitable Institutions.

The bed strength of the Hospital is over 1050. Patients belonging to all Departments such
as Medicine, Surgery, Orthopaedics, Paediatrics, Neurology, Psychiatry, Obstetrics &
Gynaecology, Skin & V.D., and so on are admitted and looked after. 750 beds are set
aside as free teaching beds with free food, free bed, free basic investigation and free
surgery. However, the purpose for which Fr. Augustus Muller our Founder started this
Hospital continues as before to “Heal and Comfort” to the less fortunate and marginalized
of our society. They are the leprosy and tuberculosis patients, psychiatric and people
addicted to drugs and alcoholism. Specialized care is extended ever since the founding of
the Hospital towards these patients.
17
OBJECTIVES
OBJECTIVES
STATEMENT OF THE PROBLEM
“A TIME AND MOTION STUDY IN THE EMERGENCY DEPARTMENT OF

FATHER MULLER MEDICAL COLLEGE HOSPITAL”
OBJECTIVES OF THE STUDY:
1. To observe the various sequential movements in emergency department.

2. To assess the time taken for each sequential movement.
18
RESEARCH
METHODOLOGY
RESEARCH METHODOLOGY
This chapter deals with methods selected by the investigator in order to study the Time and
motion study in emergency department.
RESEARCH APPROACH
The Research approach adopted in this study is Descriptive Method. This includes
collection of data using observational checklist from patients visiting emergency
department.
SAMPLE AND SAMPLING TECHNIQUE
A sample of size 100 patients was included for the study. Sample was selected using
purposive sampling technique. Observation method was adopted by the investigator to
collect the data through listing all the various sequential movements in the emergency
service from ambulance till shifting the patient to the ward and assessing time required for
each activity.
INCLUSION AND EXCLUSION CRITERIA
Data was collected for patients admitted to the emergency department during day
shift (8.30 am – 5.30 pm). Data was mainly collected for four types of units such as
Medical, Surgical, Orthopaedic and Trauma. Patients admitted at night time are
excluded.
TOOLS AND TECHNIQUES
An observational check list was prepared to collect the time required in the each
sequential movement. The check list was divided into 4 sections:
a. Demographical data
b. Time taken between the arrival of the patient and completion of evaluation
c. Time taken between ordering and completion of investigation
d. Time taken between patient arrival to admission to ward/OT/ICU or getting
discharged from emergency department
19
CONTENT VALIDITY
The tool was given to some of the experts for Content Validity and based on their
suggestions restructuring of the checklist was done.
PILOT STUDY
Pilot study was conducted for sample of 10 patients in order to assess the feasibility
of the tool and the necessary changes were made in the tool.
METHOD OF DATA ANALYSIS
Collected data was analyzed by frequencies, percentages, mean and standard

deviation. The data was presented graphically as well as in tables.
20
DATA ANALYSIS
DATA ANALYSIS
SECTION I:
Table 1: DISTRIBUTION ACCORDING TO GENDER OF THE PATIENTS
MEDICAL SURGICAL ORTHOPAEDIC TRAUMA TOTAL

SEX
f % f % f % f % %
MALE 15 60 17 68 17 68 16 64 65
FEMALE 10 40 8 32 8 32 9 36 35
TOTAL 25 100 25 100 25 100 25 100 100
The analysis shows that number of male patients was 65% and female patients were 35%.
The gender ratio was found to be more in male than female.
80
70 68 68
64
60
60
50
40
40 36
32 32
30
20
10
0
MEDICAL SURGICAL ORTHO TRAUMA
MALE FEMALE
Fig 1: GENDER WISE DISTRIBUTION OF PATIENTS
21
Table 2: DISTRIBUTION ACCORDING TO AGE OF PATIENTS

AGE
f % f % f % f % %
0-10yrs 2 8 0 0 0 0 2 8 4
11-20yrs 1 4 2 8 5 20 2 8 10
21-30yrs 1 4 2 8 6 24 7 28 16
31-40yrs 4 16 10 40 0 0 5 20 19
41-50yrs 3 12 6 24 4 16 5 20 18
51-60yrs 4 16 2 8 4 16 1 4 11
Above 60yrs 10 40 3 12 6 24 3 12 22
TOTAL 25 100 25 100 25 100 25 100 100
The analysis shows that 4% patients were of the age group 0-10yrs, 10% were of the age
group 11-20yrs, 16% were of the group 21-30yrs, 19% were of the group 31-40yrs, 18% of
the group 41-50yrs, 11% were of the age group 41-50yrs and remaining 22% were of the
age group above 60yrs. According to the data found highest patients were of the age group
above 60yrs.
40 40
40
35
30 28
24 24 24
25
20 20 20
20
16 16 16 16
15 12 12 12
10 8 8 8 8 8 8
4 4 4
5
0 0 0
0
0-10yrs 11-20yrs 21-30yrs 31-40yrs 41-50yrs 51-60yrs Above 60yrs
Fig 2: AGE WISE DISTRIBUITON OF PATIENTS
22
Table 3: DISTRIBUTION ACCORDING TO MARITAL STATUS OF PATIENTS

MARITAL
STATUS
f % f % f % f % %
MARRIED 21 84 20 80 15 60 15 60 71
SINGLE 4 16 5 20 10 40 10 40 29
TOTAL 25 100 25 100 25 100 25 100 100
The data reveals that out of 100 samples majority (71%) of them are married.
84
90 80
80
70 60 60
60
50 40 40
40
30 20
16
20
10
0
MARRIED SINGLE
Fig 3: MARITAL STATUS DISTRIBUTION OF PATIENTS
23
Table 4: DISTRIBUTION ACCORDING TO TRANSFER OF PATIENTS
PATIENT MEDICAL SURGICAL ORTHOPAEDIC TRAUMA TOTAL

TRANSFERRED f % f % f % f % %
WARD 18 72 20 80 17 68 15 60 70
OT 0 0 0 0 6 24 1 4 7
ICU 4 16 3 12 0 0 4 16 11
DISCHARGED 3 12 2 8 2 8 5 20 12
TOTAL 25 100 25 100 25 100 25 100 100
The data reveals that out of 100 patients, 70% were shifted to the ward.
80
80 72
68
70
60
60
50
40
30 24
20
20 16 16
12 12
8 8
10 4
0 0 0
0
WARD OT ICU DISCHARGED
Fig 4: PATIENT TRANSFER WISE DISTRIBUTION
24
SECTION II:
MEDICAL UNIT
Table 5(a): Total time taken between the arrival of the patient and completion of
evaluation
STANDARD
TIME TAKEN BETWEEN THE ARRIVAL OF THE MEAN
DEVIATION
PATIENT AND COMPLETION OF EVALUATION mins
mins
1 Time taken between patient arrival and registration 12.32 11.32
Time taken between patient arrival and first contact with the
2 1.80 1.5
nursing staff
Time taken between first contact with nursing staff and first
3 1.20 0.40
contact with DMO
Time taken between first contact with DMO and completion of
4 6.72 4.05
physical examination and history
Time taken between completion of physical examination and
5 3.22 2.69
history and initial treatment given by nurse
Time taken between initial treatment given by nurse and
6 4.30 3.83
information sent to the consultant
Time taken between information sent to the consultant and
7 7.55 9.89
arrival of the consultant
Time taken between arrival of the consultant and consultant
8 9.32 7.08
gave his evaluation
TOTAL TIME TAKEN BETWEEN THE ARRIVAL OF THE

34.1
PATIENT AND COMPLETION OF EVALUATION
From the above data, it is found that in the medical unit the total time taken
between patient arrival and completion of evaluation is on an average of 34.1mins.
Time taken between patient arrival and registration is an average of 12.32mins,
time taken between patient arrival and first contact with nursing staff is an average time of
1.80mins, time taken between first contact with nursing staff and first contact with DMO is
an average of 1.20mins, time taken between first contact with DMO and completion of
physical examination and history is an average of 6.72mins, time taken between
completion of physical examination & history and initial treatment given by nurse is an
average of 3.22mins, time taken between and initial treatment given by nurse and
information sent to the consultant is an average of 4.30mins, time taken between
information sent to the consultant and arrival of the consultant is an average of 7.55mins,
time taken between arrival of the consultant and consultant gave his evaluation is an
average of 9.32mins.
25
Table 5(b): Total time taken between ordering and completion of investigation
STANDARD
TIME TAKEN BETWEEN ORDERING AND MEAN
DEVIATION
COMPLETION OF INVESTIGATION mins
mins
Time taken between consultant giving his evaluation and
1 2.17 1.64
doctor prescribing diagnostic investigation
Time taken between doctor prescribing diagnostic
2 5.30 5.70
investigation and the blood been drawn from the patient
Time taken between the blood been drawn from the
3 patient and the sample been sent for laboratory 12.70 5.28
investigation
4 investigation and the patient been sent for radiology 20.18 16.32
investigation
Time taken between the patient been sent for radiology
investigation and the patient leaving the radiology
5 15.73 8.12
department and reaches casualty or discharged after
investigation
TOTAL TIME TAKEN WITH RADIOLOGY
41.57
BETWEEN ORDERING INVESTIGATION
AND COMPLETION OF WITHOUT RADIOLOGY
INVESTIGATION 7.48
INVESTIGATION
From the above data, it is found that in the medical unit the total time taken
between ordering and completion of investigation is an average time of 41.57mins if
radiology investigation is prescribed. If there is no radiology investigation then an average
time of 7.48mins.
Time taken between consultant giving his evaluation and doctor prescribing
diagnostic investigation is an average of 2.17mins, time taken between doctor prescribing
diagnostic investigation and the blood drawn from the patient is an average of 5.30mins,
time taken between the blood drawn from the patient and the sample being sent for
laboratory investigation is an average 12.70mins, time taken between doctor prescribing
diagnostic investigation and the patient is sent for radiology investigation is an average of
20.18mins,time taken between the patient is sent for radiology investigation and the patient
leaving the radiology department and reaches casualty or discharged after investigation is
an average of 15.73mins.
26
Table 5(c): Total time taken between patient arrival and admission to ward/OT/ICU
or getting discharged from emergency department
STANDARD
TIME TAKEN BETWEEN PATIENT ARRIVAL AND MEAN
DEVIATION
ADMISSION TO WARD/OT/ICU OR GETTING
mins
DISCHARGED FROM EMERGENCY DEPARTMENT mins
Time taken between patient leaving the radiology
1 department and reaches casualty or discharged after 20.52 19.66

investigation and order to shift to the ward/OT/ICU/
discharge
2 Time taken between order to shift to the ward/OT/ICU/ 17.8 14.22

discharge and when patient was shifted / discharged
TOTAL TIME TAKEN BETWEEN PATIENT ARRIVAL

AND ADMISSION TO WARD/OT/ICU OR GETTING 38.32
DISCHARGED FROM EMERGENCY DEPARTMENT
From the above table, it is found that in the medical unit the total time taken
between patient arrival to admission to ward/OT/ICU or getting discharged from
emergency department is an average of 38.32mins.
Time taken between patients leaving the radiology department and reaches
casualty or discharged after investigation and order to shift to the ward/OT/ICU/ discharge
is an average of 20.52mins, Time taken between order to shift to the ward/OT/ICU/
discharge and when patient was shifted / discharged is an average of 17.8mins.
27
SURGICAL UNIT
evaluation
STANDARD
DEVIATION
Mins
Time taken between patient arrival and first contact with
2 1 0
the nursing staff
Time taken between first contact with nursing staff and
3 1.4 0.81
first contact with DMO
Time taken between first contact with DMO and

4 4.64 1.99
completion of physical examination and history
Time taken between completion of physical examination

5 4.82 4.61
and history and initial treatment given by nurse
Time taken between initial treatment given by nurse
6 2.19 1.36
and information sent to the consultant
Time taken between information sent to the consultant
7 3.95 1.11
and arrival of the consultant
Time taken between arrival of the consultant and
8 9.09 3.63
consultant gave his evaluation
TOTAL TIME TAKEN BETWEEN THE ARRIVAL OF

27.1
THE PATIENT AND COMPLETION OF EVALUATION
From the above table, it found that in the surgical unit total time taken between
patient arrival and completion of evaluation is an average of 27.1mins.
Time taken between patient arrival and registration is an average of 6.48mins,
Time taken between patient arrival and first contact with the nursing staff is an average of
1min, Time taken between first contact with nursing staff and first contact with DMO is an
average of 1.4mins, Time taken between first contact with DMO and completion of
physical examination and history is an average of 4.64mins, Time taken between
completion of physical examination and history and initial treatment given by nurse is an
average of 4.82mins, Time taken between and initial treatment given by nurse and
information sent to the consultant is an average of 2.19mins, Time taken between
Time taken between arrival of the consultant and consultant gave his evaluation is an
28
STANDARD
MEAN
TIME TAKEN BETWEEN ORDERING AND DEVIATION
Mins
Time taken between consultant giving his evaluation and

1 2.20 1.69

2 3.8 2.68
investigation and the blood drawn from the patient
Time taken between the blood drawn from the patient and
3 12 4.27
the sample being sent for laboratory investigation

4 investigation and the patient is sent for radiology 14.06 7.52
investigation
Time taken between the patient is sent for radiology

5 28.46 12.26
investigation
WITH RADIOLOGY
TOTAL TIME TAKEN 48.54
INVESTIGATION
BETWEEN ORDERING
AND COMPLETION OF
WITHOUT RADIOLOGY
INVESTIGATION 6.01
INVESTIGATION
From the above data, it is found that in the surgical unit the total time taken
between ordering of investigation and receiving the report is an average of 48.54mins if
radiology investigation is prescribed. If there is no radiology investigation then an average
time of 6.01mins.
In which Time taken between consultant gave his evaluation and doctor prescribing
diagnostic investigation is an average of 2.20mins, Time taken between doctor prescribing
diagnostic investigation and the blood drawn from the patient is an average of 3.8mins,
Time taken between the blood drawn from the patient and the sample being sent for
laboratory investigation is an average 12mins, Time taken between doctor prescribing
diagnostic investigation and the patient is sent for radiology investigation is an average of
14.06mins, Time taken between the patient is sent for radiology investigation and the
patient leaving the radiology department and reaches casualty or discharged after
investigation was an average of 28.46mins.
29
TIME TAKEN BETWEEN PATIENT ARRIVAL AND STANDARD
MEAN
ADMISION TO WARD/OT/ICU OR GETTING DEVIATION
Mins
DISCHARGED FROM EMERGENCY DEPARTMENT Mins
department and reaches casualty or discharged after 10.6 9.49
1 discharge
Time taken between order to shift to the ward/OT/ICU/ 26 28.28
2 discharge and when patient was shifted / discharged
TOTAL TIME TAKEN BETWEEN PATIENT ARRIVAL
AND ADMISSION TO WARD/OT/ICU OR GETTING 36.6
From the above table, it is found that in the surgical unit the total time taken
Time taken between patient leaving the radiology department and reaches
discharge and when patient was shifted / discharged is an average of 26mins.
30
ORTHOPAEDIC UNIT
evaluation
STANDARD
TIME TAKEN BETWEEN THE ARRIVAL OF THE DEVIATION
MEAN
PATIENT AND COMPLETION OF EVALUATION
mins Mins

Time taken between patient arrival and first contact with
2 1.36 0.48
the nursing staff
3 1.64 0.86

4 7.48 3.99
Time taken between completion of physical examination

5 3.27 2.16
and history and initial treatment given by nurse
Time taken between initial treatment given by nurse and
6 2.2 2.06
information sent to the consultant
7 4.08 1.46
8 27.8 24.35
47.83
THE PATIENT AND COMPLETION OF EVALUATION
From the above table, it found that in the orthopaedic unit time taken between
patient arrival and completion of evaluation it takes an average time of 47.83mins.
Time taken between patient arrival and registration is an average of 6.6mins,Time
taken between patient arrival and first contact with the nursing staff is an average of
1.36min, Time taken between first contact with nursing staff and first contact with DMO is
an average of 1.64mins, Time taken between first contact with DMO and completion of
physical examination and history is an average of 7.48mins, Time taken between
completion of physical examination and history and initial treatment given by nurse is an
average of 3.27mins, Time taken between and initial treatment given by nurse and
information sent to the consultant is an average of 2.2mins, Time taken between
Time taken between arrival of the consultant and consultant gave his evaluation is an
31
STANDARD
MEAN
TIME TAKEN BETWEEN ORDERING AND DEVIATION
Mins
Time taken between consultant gave his evaluation and

1 4.36 4.73

2 4.15 4.19
investigation and the blood is drawn from the patient
Time taken between the blood is drawn from the patient

3 19.42 3.61
and the sample is sent for laboratory investigation

4 investigation and the patient sent for radiology 14.78 8.15
investigation
Time taken between the patient sent for radiology

5 28 15.83
investigation
WITH RADIOLOGY
TOTAL TIME TAKEN 51.3
INVESTIGATION
BETWEEN ORDERING OF
INVESTIGATION AND
WITHOUT RADIOLOGY
RECEIVING THE REPORT 8.52
INVESTIGATION
From the above data, it is found that in the orthopaedic unit the total time taken
between ordering and completion of investigation is an average of 51.3mins if radiology
investigation is prescribed. If there is no radiology investigation then it is an average of
8.52mins.
In which Time taken between consultant gave his evaluation and doctor prescribing
diagnostic investigation and the blood is drawn from the patient is an average of 4.15mins,
Time taken between the blood is drawn from the patient and the sample is sent for
laboratory investigation is an average of 4.36mins,Time taken between doctor prescribing
diagnostic investigation and the patient sent for radiology investigation is an average of
14.78mins, Time taken between the patient sent for radiology investigation and the patient
leaving the radiology department and reaches casualty or discharged after investigation is
an average of 28mins.
32
TIME TAKEN BETWEEN PATIENT ARRIVAL AND

MEAN STANDARD
Mins DEVIATION
mins
department and reaches casualty or discharged after 23.52 6.62
1
discharge
Time taken between order to shift to the ward/OT/ICU/ 31.92 20.11
2
discharge and when patient was shifted / discharged
TOTAL TIME TAKEN BETWEEN PATIENT
ARRIVAL AND ADMISSION TO WARD/OT/ICU OR 55.44
GETTING DISCHARGED FROM EMERGENCY
DEPARTMENT
From the above table, it is found that in the orthopaedic unit the total time taken
is an average of 23.52mins, time taken between order to shift to the ward/OT/ICU/
discharge and when patient was shifted / discharged is an average of 31.92min.
33
TRAUMA UNIT
evaluation
STANDARD
DEVIATION
mins
Time taken between patient arrival and first contact
2 1.04 0.2
with the nursing staff
3 1.68 2.80

4 6.8 3.96
Time taken between completion of physical

5 examination and history and initial treatment given by 3.00 2.27
nurse
Time taken between initial treatment given by nurse
6 2.6 2.59
and information sent to the consultant
7 6.08 4.41
8 21 17.70
THE PATIENT AND COMPLETION OF 42.2
EVALUATION
From the above table, it found that in the trauma unit the total time taken between
patient arrival and completion of evaluation is an average of 42.2mins.
Time taken between patient arrival and registration is an average of 9.4mins,time
taken between patient arrival and first contact with the nursing staff is an average of
1.04min,time taken between first contact with nursing staff and first contact with DMO is
an average of 1.68mins, time taken between first contact with DMO and completion of
physical examination and history is an average of 6.8mins, time taken between completion
of physical examination and history and initial treatment given by nurse is an average of
3mins, time taken between and initial treatment given by nurse and information sent to the
consultant is an average of 2.6mins, time taken between information sent to the consultant
and arrival of the consultant is an average of 6.08mins, time taken between arrival of the
consultant and consultant giving his evaluation is an average of 221mins.
34
STANDARD
TIME TAKEN BETWEEN ORDERING AND MEAN
DEVIATION
mins
Time taken between consultant gave his evaluation and 3.88 2.99
1
Time taken between doctor prescribing diagnostic 8 6.39
2
investigation and the blood drawn from the patient
Time taken between the blood drawn from the patient and 12.25 4.64
3
the sample is sent for laboratory investigation
4 investigation and the patient is sent for radiology 19.17 12.27
investigation
Time taken between the patient is sent for radiology
investigation and the patient leaving the radiology 35.39 17.09
5
investigation
TOTAL TIME TAKEN WITH RADIOLOGY 66.45
BETWEEN ORDERING INVESTIGATION
AND COMPLETION OF WITHOUT RADIOLOGY 11.88
INVESTIGATION INVESTIGATION
From the above data, it is found that in the trauma unit the total time taken between
ordering of investigation and completion of investigation is an average time of 66.45mins
if radiology investigation is prescribed. If no radiology investigation it is an average of
11.88mins.
Time taken between consultant giving his evaluation and doctor prescribing
diagnostic investigation and the blood drawn from the patient is an average of 8mins, time
taken between the blood drawn from the patient and the sample being sent for laboratory
investigation is an average of 12.25mins,time taken between doctor prescribing diagnostic
investigation and the patient is sent for radiology investigation is an average of 19.17mins,
time taken between the patient is sent for radiology investigation and the patient leaving
the radiology department and reaches casualty or discharged after investigation is an
35
TIME TAKEN BETWEEN PATIENT ARRIVAL AND
MEAN STANDARD
DEVIATION
DISCHARGED FROM EMERGENCY mins
mins
DEPARTMENT
department and reaches casualty or discharged 28.8 38.11
1
after investigation and order to shift to the
ward/OT/ICU/ discharge
Time taken between order to shift to the
2 ward/OT/ICU/ discharge and when patient was 33 25.04
shifted / discharged
TOTAL TIME TAKEN BETWEEN PATIENT
ARRIVAL AND ADMISSION TO WARD/OT/ICU OR 61.8
GETTING DISCHARGED FROM EMERGENCY
DEPARTMENT
From the above table, it is found that in the trauma unit the total time taken
between patient arrival and admission to ward/OT/ICU or getting discharged from
discharge and when patient was shifted / discharged is an average of 33mins.
36
Table 9(a): Average time taken between the arrival of the patient and completion of
evaluation
AVG
TIME TAKEN BETWEEN THE
M S O T TIME
ARRIVAL OF THE PATIENT AND
mins mins mins mins TAKEN
COMPLETION OF EVALUATION
mins
Time taken between patient arrival 12.32 6.48 6.6 9.4 8.7
1
and registration
Time taken between patient arrival
2 and first contact with the nursing 1.8 1 1.36 1.04 1.3
staff
Time taken between first contact
3 with nursing staff and first contact 1.2 1.4 1.64 1.68 1.48
with DMO
Time taken between first contact
4 with DMO and completion of 6.72 4.64 7.48 6.8 6.41
Time taken between completion of
5 physical examination and history and 3.22 4.83 3.27 3 3.57
initial treatment given by nurse
Time taken between initial treatment
6 given by nurse and information sent 4.30 2.19 2.2 2.6 2.82
to the consultant
Time taken between information sent
7 to the consultant and arrival of the 7.55 3.95 4.08 6.08 5.41
consultant
Time taken between arrival of the
8 consultant and consultant gave his 9.32 9.10 27.8 21 16.80
evaluation
The above data reveals the time taken from the arrival of the patient to the
completion of evaluation of all the four units.
On an average it takes 8.7mins from patient arrival to registration. At the same
time it takes 1.3mins from patient arrival to first contact with the nursing staff. Average
time taken between first contact with nursing staff and first contact with DMO is found to
be 1.48mins, average time taken between first contact with DMO and completion of
physical examination and history is 6.41mins, average time taken between completion of
physical examination and history and initial treatment given by nurse is 3.57mins, average
time taken between and initial treatment given by nurse and information sent to the
consultant is 2.82mins, average Time taken between information sent to the consultant and
arrival of the consultant is 5.41mins, average Time taken between arrival of the consultant
and consultant gave his evaluation is 16.80mins.
37
Table 9(b): Average time taken between ordering and completion of investigation
AVG
TIME TAKEN BETWEEN M S O T TIME
ORDERING AND COMPLETION TAKEN
OF INVESTIGATION mins mins mins mins
mins
Time taken between consultant gave

1 his evaluation and doctor 2.17 2.21 4.36 3.88 3.16
prescribing diagnostic investigation
Time taken between doctor

2 prescribing diagnostic investigation 5.30 3.80 4.16 8.00 5.32
and the blood drawn from the patient
Time taken between the blood

drawn from the patient and the
3 12.70 12.00 19.42 12.25 14.09
sample is sent for laboratory
investigation
Time taken between doctor

prescribing diagnostic investigation
4 20.18 14.07 14.78 19.17 17.05
and the patient is sent for radiology
investigation
Time taken between the patient been

sent for radiology investigation and
5 the patient leaving the radiology 13.91 28.47 28.00 35.39 26.44
department and reaches casualty or
discharged after investigation
The above table reveals the average time taken between ordering and completion
of investigation in a sequence. In the average time taken between consultant gave his
evaluation and doctor prescribing diagnostic investigation is found to be 3.16mins,
average time taken between doctor prescribing diagnostic investigation and the blood
drawn from the patient is 5.32mins, average time taken between the blood drawn from the
patient and the sample is sent for laboratory investigation is 14.09mins, average time
taken between doctor prescribing diagnostic investigation and the patient is sent for
radiology investigation is 17.05mins, average time taken between the patient is sent for
radiology investigation and the patient leaving the radiology department and reaches
casualty or discharged after investigation is 26.44mins.
38
Table 9(c): Average time taken between patient arrival and admission to
TIME TAKEN BETWEEN PATIENT
AVG
ARRIVAL AND ADMISSION TO
M S O T TIME
WARD/OT/ICU OR GETTING
mins mins mins mins TAKEN
DISCHARGED FROM EMERGENCY
mins
DEPARTMENT
Time taken between patient leaving the
radiology department and reaches
1 casualty or discharged after 20.52 10.6 23.52 28.8 20.86
investigation and order to shift to the
ward/OT/ICU/ discharge
Time taken between order to shift to the
2 ward/OT/ICU/ discharge and when 17.8 26 31.92 33 27.18
patient was shifted / discharged
From the above table the average time taken between patient arrival to admission
to ward/OT/ICU or getting discharged from emergency department in sequence is given
below. Average time taken between patient leaving the radiology department and reaches
is found to be 20.86mins, average time taken between order to shift to the ward/OT/ICU/
discharge and when patient was shifted / discharged is 27.18mins.
39
Table 10: Average time taken between patient arrival and discharge
AVG
TIME TAKEN BETWEEN
SL. TIME
PATIENT ARRIVAL AND M S O T
NO TAKEN
DISCHARGE mins mins mins mins
Mins
Time taken between the
arrival of the patient and 34.1 27.1 47.83 42.2 37.80
1
With
Time taken
radiology 41.57 48.54 51.3 66.45 51.96
between
investigation
ordering and
2 Without
completion of
radiology 7.48 6.01 8.52 11.88 8.47
investigation
investigation
Time taken between patient
arrival and admission to
ward/OT/ICU or getting 38.32 36.6 55.44 61.8 48.04
3
discharged from emergency
department
Total time taken With
between patient radiology 113.99 112.24 154.57 170.44 137.81
arrival and investigation
admission to
ward/OT/ICU or Without
getting discharged radiology 79.9 69.71 111.79 115.88 94.32
from emergency investigation
department
Time taken between the arrival of the patient and completion of evaluation for
patients in medical unit is found to be 34.1mins, for surgical unit is 27.1mins, for
orthopaedic unit is 47.83mins and for trauma unit is 42.2mins.The total average time taken
is found to be 37.80mins.
40
Time taken between ordering and completion of investigation with radiology
investigation is found to be 41.57mins for medical unit, 48.54mins for surgical unit,
51.3mins for orthopaedic unit and 66.45mins for trauma unit. The total average time taken
Time taken between ordering and completion of investigation without radiology

investigation is found to be 7.48mins for medical unit, 6.01mins for surgical unit, 8.52mins
for orthopaedic unit and 11.88mins for trauma unit. The total average time taken is found
to be 8.47mins.
Time taken between patient arrival and admission to ward/OT/ICU or getting

discharged from emergency department for medical unit it is found to be 38.32mins, for
surgical unit is 36.6mins, for orthopaedic unit 55.44mins and for trauma unit is 61.8mins.
The total average time taken is found to be 48.04mins.
Therefore the total time taken between patient arrival and admission to
ward/OT/ICU or getting discharged from emergency department with radiology
investigation for medical unit is found to be 113.99mins, for surgical unit is 112.24mins,
for orthopaedic unit is 154.57mins, and for trauma unit is 170.44mins. The total time taken
The total time taken between patient arrival and admission to ward/OT/ICU or
getting discharged from emergency department without radiology investigation for medical
unit is found to be 79.99mins, for surgical unit is 69.71mins, for orthopaedic unit is
111.79mins, and for trauma unit is 115.88mins. The total time taken is found to be
94.32mins.
41
INTERPRETATION
OF DATA
INTERPRETATION OF DATA
Emergency services are the providers of acute medical care to patients with
illness and injuries in emergency situations. Usually emergencies involve life endangered
situations. In such situations prompt and calm action is required. Sequencing the
movements and benchmarking time helps to increase efficiency in delivering the service.
Sequencing the movements in any service helps to reduce unnecessary

movements, for quick delivery of service, more patients can be treated, reduces the time
and effort of the personnel involved. This helps in delivering quality of service to the
patient in distress. Also determining the time for each movement helps to identify the
reasons for delay and take necessary actions.
This time and motion study was conducted to determine various sequential
movements and time taken for each movement to identify unnecessary movements and
benchmark the time.
DETERMINING VARIOUS SEQUENTIAL MOVEMENTS:
The sequential movements observed during study period in ED from patient

arrival to patient discharge among the four units of patients i.e. medical, surgical,
orthopaedic and trauma units were found.
 Patient arrival
o Patients usually arrive either through ambulance, any other vehicles or self
arrival.
o If patients needed, stretcher or wheel chair was provided.
o The patients are assisted by DMO, a staff nurse, and ward boy and security
person to shift to the emergency ward.
 First contact with the nursing staff and DMO
o The nursing staff will assist the person from the ambulance till the patient
is shifted to the ED by providing preliminary care.
 Registration
o While the patient is attended by the DMO, the patient party or the attender
is asked to do the registration in the MRD.
42
 Completion of physical examination and history
o Complete physical examination of the patient is done by the DMO such as
checking of vital signs, ECG is taken, IV is given and simultaneously
previous history of the patient is asked and recorded in the medical record
file.
 Initial treatment
o According to patient’s condition initial treatment is given.
 Information sent to the consultant
o Then the information is sent to the respective unit doctors according to the
type of injury or illness.
 Arrival of consultant
o Consultant on arrival will examine the patient and give necessary
directions.
 Evaluation
o The consultant will explain the patient party about the patient condition and
suggests the treatment. If required asked for other unit referral.
o In minor cases the initial treatment is given and the patient is discharged.
o In critical conditions the patient is directly sent to OT or ICU’s.
 Prescribing diagnostic investigation
o Diagnostic investigation is prescribed based on the requirement for
radiology or laboratory investigation.
 Collection of blood samples
o For lab investigation blood sample is collected.
 Sample sent to lab
o Then the blood sample is sent to lab
 Patient sent for radiology department
o Mean while if radiology investigation is prescribed the patient is sent for
radiology department with the ward boy and attender.
o If there is no radiology investigation patient is directly sent to the ward or
discharged.
 Discharge
o After radiology investigation is complete the report directly sent to the
ward if patient is shifted to the ward.
43
o If patient is directly discharged from ED the report is explained to the
patient and medicine prescription is given.
o If minor suturing is done the patient is discharged directly and asked to
come for removal of stitches within the time given by the doctor.
TIME TAKEN FOR EACH MOVEMENT
Total Time taken between the arrival of the patient and completion of evaluation
The analysis of this time factor revealed that the total time taken between the
arrival of the patient and completion of evaluation is 37.80mins. In this the mean time
taken for medical unit is found to be 34.1mins, for surgical unit 27.1mins, for orthopaedic
unit 47.83mins, and for trauma unit 42.2mins. It is found that more time was taken for
orthopaedic unit (i.e. 47.83mins) between patient arrival and completion of evaluation.
Time taken between ordering and completion of investigation
The mean Time taken between ordering and completion of investigation with
radiology investigation is 51.96mins. In this the medical unit took 41.57mins, for surgical
unit 48.54mins, for orthopaedic unit 51.3mins and for trauma unit 66.45mins. It is found
that trauma unit (i.e. 66.45mins) took more time between ordering and completion of
evaluation if radiology investigation was prescribed.
Meanwhile the total time taken between ordering and completion of investigation
without radiology investigation is 8.47mins. In this the time taken for medical, surgical,
orthopaedic and trauma units was 7.48mins, 6.01mins, 8.52mins and 11.88mins
respectively. In is found that trauma unit took more time between ordering and completion
of investigation even though no radiology investigation was prescribed.
Time taken between patient arrival and admission to ward/OT/ICU or getting

The total Time taken between patient arrival and admission to ward/OT/ICU or
getting discharged from emergency department is 48.04mins. In this the medical unit took
38.32mins, surgical unit took 36.6mins, orthopaedic unit took 55.44mins and trauma unit
took 61.8mins. It is found that more time is taken for trauma unit (i.e. 61.8mins).
44
Total time taken between patient arrival and admission to ward/OT/ICU or getting
The average time taken between patient arrival and admission to ward/OT/ICU or
getting discharged from emergency department with radiology investigation is found to be
137.81mins and without radiology investigation is found to be 94.32mins.
In this the four units medical, surgical, orthopaedic and trauma units average time taken
with radiology investigation is found to be 113.99mins, 112.24mins, 154.57mins and
170.44mins respectively.
Meanwhile the average time taken for medical, surgical, orthopaedic and trauma
units without radiology investigation is found to be 79.9mins, 69.71mins111.79mins and
115.88mins respectively.
BENCHMARKING TIME INTERVAL IN COMPARISON WITH

INTERNATIONAL BENCHMARKS
When assessed with the international benchmarks the total length of stay for
admitted patients was found to be 120 – 240 minutes and total length of stay for discharged
patients was 60-90 minutes. The above study showed the average length of stay for any
unit (with or without radiology investigation) was found to be around 116 minutes which is
within the recommended time interval. Hence these time interval found for each movement
in emergency department can be benchmark for a hospital for further improvement.
45
FINDINGS
AND SUGGESTIONS
FINDINGS
The time and motion study was conducted to determine various sequential
movements and time taken for each movement in the ED through checklist was identified
to eliminate unnecessary movements and benchmark the time.
The following sequential movements were identified:
 Patient arrival
 First contact with the nursing staff and DMO
 Registration
 Completion of physical examination and history
 Initial treatment
 Information sent to the consultant
 Arrival of consultant
 Evaluation given by the consultant
 Prescribing diagnostic investigation
 Collection of blood samples
 Sample sent to lab
 Patient sent for radiology department
 Discharge
The time found out for each movement was:
TIME TAKEN BETWEEN THE ARRIVAL OF THE PATIENT AND

COMPLETION OF EVALUATION
 Time taken between patient arrival and registration
The average time taken between patient arrival and registration is found to be
8.7mins. In this the medical unit took more time between patient arrival and
registration (i.e.12.32mins) compared to other units i.e. surgical unit took
6.48mins, orthopaedic unit took 6.6mins and trauma unit took 9.4mins.
46
 Time taken between patient arrival and first contact with nursing staff and DMO
On an average time taken between patient arrival and first contact with nursing
staff and DMO is found to be approximately 2-3mins. It is found that all the units
took almost same time.
 Time taken between first contact with nursing staff and DMO and completion of
It is found that on an average it took 6.41mins between first contact with nursing
staff and DMO and completion of physical examination and history. In this
sequence orthopaedic unit (7.48mins) took more time than other units i.e. more
than medical, surgical and trauma units (6.72mins, 4.64mins and 6.8mins).
 Time taken between completion of physical examination and history and initial
treatment given by nurse
An average time taken between completion of evaluation and history and

initial treatment given by nurse is 3.57mins. In this all the units took almost the
same time i.e. 3-4mins.
 Time taken between initial treatment given by nurse and information sent to the
consultant
An average time taken between initial treatment given by nurse and information
sent to the consultant is 2.82mins. It is found that medical unit took 4.30mins,
surgical unit took 2.19mins, orthopaedic unit took 2.2mins and trauma unit took
2.6mins. In this case medical unit took more time than other units.
 Time taken between information sent to the consultant and arrival of the
consultant
An average time taken between information sent to the consultant and arrival of
the consultant is found to be 5.41mins. Comparatively it is found that medical
unit took more time than other units i.e. 7.55mins compared to 3.95mins for
surgical unit, 4.08mins for orthopaedic unit and 6.08mins for trauma unit.
 Time taken between arrival of the consultant and consultant giving his evaluation
An average time taken between arrival of the consultant and consultant giving his
evaluation is found to be 16.80mins. In this it is found that orthopaedic unit
(27.8mins) took more time compared to other units i.e. 9.32mins for medical unit,
9.10mins for surgical unit and 21mins for trauma unit.
47
TIME TAKEN BETWEEN ORDERING AND COMPLETION OF
INVESTIGATION
 Time taken between consultant giving his evaluation and doctor prescribing
diagnostic investigation
It is found that it took on an average 3.16mins to complete his evaluation and
prescribe diagnostic investigation. In this it is comparatively found that all the
units took almost the same time i.e. 3-4mins.
 Time taken between doctor prescribing diagnostic investigation and the blood
drawn from the patient
An average time of 5.52mins were taken between doctor prescribing diagnostic
investigation and blood drawn from the patient. Comparing the unit times it is
found that trauma unit (8.00mins) took more time than other units i.e. 5.30mins
for medical unit, 3.80mins for surgical unit and 4.16mins for orthopaedic unit.
 Time taken between blood drawn from the patient and the sample is sent for
laboratory investigation
It is found that an average time taken between blood been drawn from the patient
and the sample been sent for laboratory investigation is 14.09mins. For each unit
it is found to be 12.70mis for medical unit, 12.00mins for surgical unit,
19.42mins for orthopaedic unit and 12.25mins for trauma unit. Comparing it is
found that orthopaedic unit took more time than other units.
 Time taken between doctor prescribing diagnostic investigation and the patient
been sent for radiology investigation
It is seen that average time taken between doctor prescribing diagnostic
investigation and the patient been sent for radiology investigation is 17.05mins.
In this situation the medical unit (20.18mins) has taken more time compared to
surgical unit (14.07mins), orthopaedic unit (14.78mins) and trauma unit
(19.17mins).
 Time taken between the patient been sent for radiology investigation and the
patient leaving the radiology department and reaches casualty or discharged after
investigation
On an average time taken is found to be 26.44mins. In this case trauma unit
(35.39mins) took more time compared to medical unit (13.91mins), surgical unit
(28.47mins) and orthopaedic unit (28.00mins).
48
TIME TAKEN BETWEEN PATIENT ARRIVAL AND ADMISSION TO
WARD/OT/ICU OR GETTING DISCHARGED FROM EMERGENCY
DEPARTMENT
 Time taken between patient leaving the radiology department and reaches
casualty or discharged after investigation and order to shift to the ward/OT/ICU/
discharge
The average time taken between patient leaving the radiology department and
reaches casualty or discharged after investigation and order to shift to the
ward/OT/ICU/ discharge is found to be 20.86mins. Time taken for each unit is
20.52mins for medical unit, 10.6mins for surgical unit, 23.52mins for orthopaedic
unit and 28.8mins for trauma unit. Comparing it is seen that trauma unit has taken
more time compared to other units.
 Time taken between order to shift to the ward/OT/ICU/ discharge and when
patient was shifted / discharge
The average time taken between order to shift to the ward/OT/ICU/ discharge and
when patient was shifted / discharge is found to be 27.18mins. The time taken for
trauma unit (33mins) is found to be more compared to medical unit (17.8mins),
surgical unit (26mins) and orthopaedic unit (31.92mins)
49
SUGGESTIONS
The time and motion study conducted in emergency department helped to identify
the various sequential movements involved and time interval for each movement in
emergency services. The study was conducted among four units. Some of delays in the
movements were observed by the investigator which in turn increases the length of stay of
patients in the emergency.
The following recommendations can be adopted to provide quick service and

increase the quality of patient care.
 Appointment of experienced patient coordinator to help patient/relatives to

complete registration and billing procedure
 Protocol should be made, where the emergency cases should get priority for
radiological investigations and laboratory investigations over normal cases.
 The time intervals identified for each sequential movement in emergency
department are found in terms with international benchmarks. Hence international
benchmarks can be considered as benchmarks for the hospital and any negative
deviations for these benchmarks can be identified and corrected.
50
CONCLUSION
CONCLUSION
The casualty department provides round the clock immediate diagnosis and
treatment of illness of an urgent nature. Patients with injuries from accident cases of
serious nature are admitted in emergency unit to provide immediate medical care.
Casualty service brings about an interface between the hospital and the
community, which is emotionally surcharged. Hence giving prompt and efficient services
to the patient arriving at an accident and emergencies are two very factors to be
considered.
Sequencing the movements and determining the time interval for each movement
helps to develop a systematic protocol for emergency department
In this regard to provide efficient and effective services in the ED the above time
and motion study was conducted which helped to understand the sequential movements
involved and determine the time required for each movement. When compared with the
international benchmark the identified patient length of stay in ED was found to be within
the standard.
51
BIBLIOGRAPHY
BIBLIOGRAPHY
1. http://www.fuzeqna.com/ump/consumer/kbdetail.asp?kbid=433
2. Marvin D Feit, Stanley F Battle. Health and Social policy. 1995; 24p.
3. Dr. Kumar Vasanth. Selected Reading in Hospital Administration published in IHA

New Delhi. 1990; 180p.
4. S.M Jha, Hospital management, Himalaya publishing house management of

hospital administration, 1st Ed, 2001; 1362p.
5. Francis C.M. & De Souza Mario C. Hospital Administration. 3rd Ed; page-172
6. Hospitals: What they are and how they work? I. Donald Snook, Jr 2nd Ed, 240p.
7. S.L Goel, R.Kumar, Hospital Core Services. Hospital administration in the 21st
century. Deep and Deep publication pvt ltd 2004, 10p.
8. Martin S. Karpiel, Healthcare Financial Management, Benchmarking Facilitates Process

Improvement in the Emergency Department, May
9. Adler, Paul. “Democratic Taylorism”: The Toyota Production System at NUMMI.

In Lean Work: Empowerment and Exploitation in the Global Auto Industry, ed.
Steve Babson, Detroit, MI: Wayne State University Press,1995, 207–219pp
10. Chhabra T. N. Principles and Practice of Management. 9th Ed; University of Delhi,
2005; 75p.
11. Kyriacou DN, Ricketts V, Dyne PL, McCollough D, Talan DA: A 5-year time
study analysis of emergency department patient care efficiency. Ann Emerg Med
September 1999; 34:326-335pp
52
12. Ann Hendrich, Marilyn Chow, Boguslaw A Skierczynski, Zhenqiang Lu, "How
Medical-Surgical Nurses Spend Their Time in ED”. The Permanente Journal/
Summer 2008, Volume 12 No. 3
13. Time study of patient movement through the emergency department: Sources of
delay in relation to patient acuity Annals of Emergency Medicine Volume 16, Issue
11, November 1987, Pages 1244-1248pp.
14. http://www.biomedcentral.com/1471-227X/10/16
15. Identification of Root Causes for Emergency Diagnostic Imaging Delays at Three
Canadian Hospitals Volume 32, Issue 4, Pages 276-280 (August 2006)
16. Purnell,L. reducing waiting time in emergency stage, nurse management. 1995
September, 29(9), 640, 647, 64v
17. Peter R Kongstvedt, The managed health care hand book 4th edition aspen
publications. The emergency department and managed care Casey Jason and Meera
Kanhouwa,356-57pp
18. Francis C.M, casualty services, hospital administration, jaypee brothers, 1995,179p.
19. Paine.S, a report of the finding of a 1 year study of the waiting times among
patients attending an accident an accident and emergency department, accident-
emergency nursing, 1994, 2(3),130-3pp
20. Mohammad A. Tashkandy, Zohair Jamil Gazzaz, Mian Usman Farooq, Khalid O.
Dhafar , Reasons for delay in inpatient admission at an Emergency department.
http://www.ayubmed.edu.pk/JAMC/PAST/20-1/Tashkandi.pdf
21. John T. Talty .Industrial hygiene engineering: recognition measurement and

evaluation 2nd edition , 725p
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22. Macaulay H M C, Llewelyn Davis. R. Hospital planning and administration, 1995,
1p
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and Deep Publications Pvt Ltd, 2004,10p
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Walley, Sue Wilson. Reducing Attendances and Waits in Emergency Departments,
January 2004, A systematic review of present innovations Report to the National
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(NCCSDO) January 2004.
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emergency department ,Emerg Med J 2006; 23:286-290 Volume 23, Issue 4, 2005
54
ANNEXURE
OBSERVATION CHECKLIST
SECTION I
1 Case
2 Age
A. 0-10yrs
B. 11-20yrs
C. 21-30yrs
D. 31-40yrs
E. 41-50yrs
F. 51-60yrs
G. Above 60yrs
3 Marital status
A. Married
B. Single
4 Sex
A. Male
B. Female
SECTION II
Section A:
TIME TAKEN BETWEEN THE ARRIVAL OF THE PATIENT AND
COMPLETION OF EVALUATION:
1 Time of patient arrival
2 Time of registration
3 Time first contact with the nursing staff
4 Time of first contact with DMO
Time at which medical staff completed physical examination and

5
history
6 Time at which initial treatment was given nurse
7 Time of information sent to the consultant
8 Time of arrival of the consultant
9 Time at which consultant gave his evaluation
55
Section B:
TIME TAKEN BETWEEN ORDERING OF INVESTIGATION AND

RECEIVING THE REPORT:
1 Time the doctor prescribes diagnostic investigation
2 Type of laboratory investigation
3 Time the blood is drawn from the patient
4 Time the sample is sent for laboratory investigation
5 Type of radiology investigation
6 Time the patient is sent for radiology investigation
Time the patient leaves the radiology department after
7
investigation
Section C:
TIME TAKEN BETWEEN PATIENT ARRIVAL AND ADMISSION

TO WARD/OT/ICU OR GETTING DISCHARGED FROM
EMERGENCY DEPARTMENT:
1 Patient is shifted to
A. Ward
B. OT
C. ICU
D. Discharged
2 Time of order to shift to the ward/OT/ICU/ discharge
3 Time when patient was shifted / discharged
56

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A TIME AND MOTION STUDY IN THE

EMERGENCY DEPARTMENT OF FATHER MULLER

Ms. VENISHA NAINA D’SOUZA

MASTERS IN HOSPITAL ADMINISTRATION

UNDER THE GUIDANCE OF

Mrs. SONIA E D’SOUZA, LECTURER

DEPARTMENT OF HOSPITAL ADMINISTRATION

DECLARATION BY THE CANDIDATE

AND MOTION STUDY IN THE EMERGENCY DEPARTMENT OF FATHER

MULLER MEDICAL COLLEGE HOSPITAL” is a bonafide and genuine research

LECTURER, Department of Hospital Administration, Father Muller Medical College,

Date: Ms. VENISHA NAINA D’SOUZA

EMERGENCY DEPARTMENT OF FATHER MULLER MEDICAL COLLEGE

HOSPITAL” is a bonafide research work done by Ms. VENISHA NAINA D’SOUZA in

been submitted elsewhere for any other degree or diploma.

Date MRS. SONIA E D’SOUZA

EMERGENCY DEPARTMENT OF FATHER MULLER MEDICAL COLLEGE

HOSPITAL” is a bonafide research work done by VENISHA NAINA D’SOUZA under

the guidance of Mrs. SONIA E D’SOUZA, LECTURER, Department of Hospital

Administration, Father Muller Medical College, Mangalore. This project is submitted to

DR. JAYAPRAKASH ALVA, M.D. DR. JAYAPRAKASH ALVA, M.D

Place: Mangalore Place: Mangalore

DECLARATION BY THE CANDIDATE

project in print or electronic format for academic / research purpose.

VENISHA NAINA D’SOUZA

© Rajiv Gandhi University of Health Sciences, Karnataka

Firstly, I would like to like to acknowledge the support and encouragement

I am grateful to Rev. Fr. Patrick Rodrigues, The Director of Father Muller

My heart filled gratitude to my guide Mrs. Sonia E D’Souza, Lecturer,

I avail this opportunity to express deep sense of gratitude to Mrs. Sucharita

I wish to express my heartfelt thanks to Sister In-charge of emergency department

Finally, I would like to express my appreciation and gratitude to all my Friends

Thank you one and all

Venisha Naina D’Souza

DMO- Deputy Medical Officer

ED- Emergency department

CHAPTER NO TITLE PAGE NO

INTRODUCTION AND REVIEW OF 1

OBJECTIVES AND RESEARCH 18

FINDINGS AND SUGGESTIONS 46

SL.NO TABLES PAGES

7(b) Total time taken between ordering and completion of investigation 32

Total time taken between patient arrival to admission to

8(b) Total time taken between ordering and completion of investigation 35

Total time taken between patient arrival to admission to

10 Average time taken between patient arrival and discharge 40

SL.NO FIGURES PAGES

1 Gender wise distribution of patients 21

2 Age wise distribuiton of patients 22

Marital status wise distribution of

Patient transfer wise distribution 24

1. To improve the methods or procedures adopted in performance of various jobs.

According to Marvin D Feit et al [2] the American college of emergency physician

Kinds of medical emergencies:

* How long did I wait?

Time and motion study:

Different areas of delay in ED:

Sequential emergency procedures:

RECEPTION AND WAITING ROOM

EXAMINATION, DIAGNOSIS, TRAETMENT

(Theatre, plaster room, recovery beds)

Out patients In patients General Another hospital

Reception and enquiry

Admission Keeping under examination Dressing