Background: The emergency department (ED) waiting room duration has been a challenge in many EDs. This study has implemented a focus plan-do-study-act (PDSA) cycle study on ED waiting room patients in a private hospital in Kuwait. Each PDSA cycle included one of the following interventions: hospitality measures, number of triage nurses, number of ED physicians, and number of receptionists to see their impact on the ED waiting times. Methods: The waiting times were collected per patient coming into the ED and their assigned Canadian Triage Acuity Scale (CTAS) level over a 12-month period, as well as the number of patients left without being seen (LWBS). Each intervention was introduced into the ED and a 2-month period following each was given to see the effect on the waiting time. Results: As divided per CTAS level, there were 38,157 patients included in the analysis. The results showed that for every increase in one triage nurse, there was a reduction of 15.09, 20.7, and 20.8 minutes for CTAS 3, 4, and 5 patients, respectively, and for every increase in one doctor there was a reduction in the total ED waiting room time of 11.4, 10.0, and 8.6 minutes for CTAS 3, 4, and 5 patients, respectively, keeping all other variables constant. These quality parameters reduced the LWBS from 6.1% to 2.5%. Conclusion: This study concluded that increasing triage nurses and ED physicians successfully reduces total ED waiting room times and reduces the number of patients LWBS.

Keywords: Quality improvement, emergency department, waiting room times, emergency medicine, CTAS.