Owen Johnson

In the last 6 years, hospitals in developed countries have been trialling the use of command centres for improving organizational efficiency and patient care. However, the impact of these command centres has not been systematically studied in the past. It is a retrospective population-based study. Participants were patients who visited the Bradford Royal Infirmary hospital, Accident and Emergency (A&E) Department, between 1 January 2018 and 31 August 2021. Outcomes were patient flow (measured as A&E waiting time, length of stay, and clinician seen time) and data quality (measured by the proportion of missing treatment and assessment dates and valid transition between A&E care stages). Interrupted time-series segmented regression and process mining were used for analysis. A&E transition time from patient arrival to assessment by a clinician marginally improved during the intervention period; there was a decrease of 0.9 min [95% confidence interval (CI): 0.35–1.4], 3 min (95% CI: 2.4–3.5), 9.7 min (95% CI: 8.4–11.0), and 3.1 min (95% CI: 2.7–3.5) during ‘patient flow program’, ‘command centre display roll-in’, ‘command centre activation’, and ‘hospital wide training program’, respectively. However, the transition time from patient treatment until the conclusion of consultation showed an increase of 11.5 min (95% CI: 9.2–13.9), 12.3 min (95% CI: 8.7–15.9), 53.4 min (95% CI: 48.1–58.7), and 50.2 min (95% CI: 47.5–52.9) for the respective four post-intervention periods. Furthermore, the length of stay was not significantly impacted; the change was −8.8 h (95% CI: −17.6 to 0.08), −8.9 h (95% CI: −18.6 to 0.65), −1.67 h (95% CI: −10.3 to 6.9), and −0.54 h (95% CI: −13.9 to 12.8) during the four respective post-intervention periods. It was a similar pattern for the waiting and clinician seen times. Data quality as measured by the proportion of missing dates of records was generally poor (treatment date = 42.7% and clinician seen date = 23.4%) and did not significantly improve during the intervention periods. The findings of the study suggest that a command centre package that includes process change and software technology does not appear to have a consistent positive impact on patient safety and data quality based on the indicators and data we used. Therefore, hospitals considering introducing a command centre should not assume there will be benefits in patient flow and data quality.