Investigating the Effect of Clinical Governess Approach on Patients' Length of Stay in Emergency Department: an Action Research Study


Over the past decade, clinical governance approach with aims to improve the quality of health services has been proposed in Iran. Considering the obvious problems especially patients' length of stay (LOS) in the emergency departments (EDs); the present study has been carried out with the purpose of Investigating the effect of clinical governess approach on patients' LOS in the one of the largest medical centers in the country. After the problem was specified by the 17 interviews with employees and managers of the ED; the emergency clinical governance committee was formed by two academic researchers and seven ED staff (key participants) that had the most involvement with the subject of study. The activities of the committee, including planning, acting, observing and reflecting, was organized by using participatory action research approach and action research cycle (Kemmis 1995). During this time, three formal meetings with key participants were held in 6-month intervals. Monthly records of patients' average LOS and interview with ED staff were used to analyze the findings. The research was completed with two cycles in one year. Committee members took the following actions. As a result, the patients' LOS reduced from 2.68 days to 1.73 days. Make regular patients visits by medical groups especially orthopedists and neurologists; Decision making about patients situation by emergency physicians and transferring patients to the relevant units by bed managers; Refusing to admit elective patients during overcrowding times; to regulate the list of patients requiring ICU by anesthesiologists. Prolonged LOS can be due to various causes and a team approach, which is one of the requirements of clinical governance approach, is needed to manage it. The results showed that the multidisciplinary team could make positive changes and reduce LOS in emergency setting.

O'Connor RE, Sama A, Burton JH, et al. Procedural Sedation and Analgesia in the Emergency Department:Recommendations for Physician Credentialing, Privileging, and Practice. Ann Emerg Med 2011;58(4):365-70.

Calleja P, Forrest L. Improving patient privacy and confidentiality in one regional Emergency Department-A quality project. Aust Emerg Nurs J 2011;14(4):251-6.

Considine J, Smith R, Hill K, et al. Older peoples’ experience of accessing emergency care. Aust Emerg Nurs J 2010;13(3):61-9.

McHugh M, Van Dyke K, Yonek J, et al. A Collaborative to Improve Patient Flow and Reduce Emergency Department Crowding: The Urgent Matters Learning Network II Experience. Ann Emerg Med 2010;56(3):S92.

Pham JC, Trueger NS, Hilton J, et al. Interventions to Improve Patient-centered Care during Times of Emergency Department Crowding. Acad Emerg Med 2011;18(12):1289-94.

Hatamabadi H, Mohammadi A. Reasons for Long-Stay Admission in a Typical Overcrowded Emergency of A Teaching Hospital in Tehran Capital City. Pajouhandeh 2008;13(1):71-5.

Pines JM, Hollander JE. Emergency department crowding is associated with poor care for patients with severe pain. Ann Emerg Med 2005;51(1):1-5.

Rumoro D, Shah S, Patel A, et al. Managing Patient Expectations at Emergency Department Triage. Ann Emerg Med 2009;54(3):S52.

Mason S, Weber EJ, Coster J, et al. Time Patients Spend in the Emergency Department:England's 4-Hour Rule—A Case of Hitting the Target but Missing the Point? Ann Emerg Med 2011;59(5):341-9.

Golaghaie F, Sarmadian H, Rafiie M, et al. A study on waiting time and length of stay of attendants to emergency department of Vali-e-Asr Hospital, Arak-Iran. Arak Univ Med Sci J 2008;11(2):74-83.

Asadi F. Improvement of hospital emergency services by quality management system approach. CIVILICA. (Accessed in Feb 14, 2014, at T04-QUALITYMANAGEMENT04_056.html).

Gauld R, Horsburgh S, Brown J. The clinical governance development index:results from a New Zealand study. BMJ Qual Saf 2011;20(11):947-52.

Mohamadpour M. clinical governance and organizing emergency departments. (Accessed in Feb 14, 2014, at

Jalili M, Mostashar Nezami M, Siahtir M, editors. Evaluation of patient’s satisfaction with emergency medical services in Emam Khomeini hospital. Proceedings of 2nd annual congress on emergency medicine. 2007 May. 28, Tehran, Iran. Ardabil: Ardabil Univ Med Sci; 2008.

Nayeri ND, Aghajani M. Patients’ privacy and satisfactionin the emergency department:a descriptive analytical study. Nurs Ethics 2010;17(2):167-77.

Saadati Z. Satisfaction of clients referring to emergency wards of a teaching hospital in Mashhad city. J Nurs Midwifery 2006;16(25):40-7.

Soleimanpour H, Gholipouri C, Salarilak S, et al. Emergency department patient satisfaction survey in Imam Reza Hospital, Tabriz, Iran. Int J Emerg Med 2011;4(1):2.

Quinn PT. The evolving role of the patient advocate in the emergency department:The experience of one community hospital. J Emerg Nurs 2009;35(1):48-9.

David Ng, Gord Vail, Sophia Thomas, et al. Applying the Lean principles of the Toyota Production System to reduce wait times in the emergency department. CJEM 2010;12(1):50-7.

Coughlan M, Corry M. The experiences of patients and relatives/significant others of overcrowding in accident and emergency in Ireland:A qualitative descriptive study. Accid Emerg Nurs 2007;15(4):201-9.

Derlet R, Richards J, Kravits R. Frequent Overcrowding inU.S. Emergency Departments. Acad Emerg Med 2001;8(2):151-5.

Kocher KE, Meurer WJ, Desmond JS, et al. Effect of Testing and Treatment on Emergency Department Length of Stay Using a National Database. Acad Emerg Med 2012;19(5):525-34.

Gardner RL, Sarkar U, Maselli JH, et al. Factors associated with longer ED lengths of stay. Am J Emerg Med 2007;25(6):643-50.

Jus E. Factors influencing length of stay in the Emergency Department in a Private Hospital in North Jakarta. Univ Med 2008;27(4):1 65-73.

Bekmezian A, Chung PJ, Cabana MD, et al. Factors Associated With Prolonged Emergency Department Length of Stay for Admitted Children. Pediatr Emerg Care 2011;27(2):110-5.

Improving the patient experience for Aboriginal people in the emergency department. Department of Health. (Accessed in Feb 14, 2014, at 3FCA257AD20040A37D/$FILE/ipe_aboriginal_ed.pdf (.

Wagner MJ, Wolf S, Promes S, et al. Duty hours in emergency medicine:balancing patient safety, resident wellness, and the resident training experience:a consensus response to the 2008 institute of medicine resident duty hours recommendations. Acad Emerg Med 2010;17(9):1004-11.

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Clinical governance Length of stay Emergency service Hospital

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How to Cite
Salehi T, Nayeri ND, Rashidian A, Mohammadi E. Investigating the Effect of Clinical Governess Approach on Patients’ Length of Stay in Emergency Department: an Action Research Study. Acta Med Iran. 1;52(2):137-145.