Improving emergency department efficiency by patient streaming to outcomes-based teams

Abstract

Objective: To describe the process and results of a process redesign based on task analysis and lean thinking approaches aimed at improving emergency department (ED) efficiency. Methods: Before-and-after study comparing 12- month periods before and after the process redesign for total episodes of ambulance bypass, waiting times (overall and by triage category) and total ED time (overall and by triage category). Time data were analysed using non-parametric methods. Results: The years were broadly comparable, with the exception that there was an 8.4% increase in total hours of care delivered (a marker of ED workload) in the year after the change. Episodes of ambulance bypass reduced by 55% (120 v 54). There were statistically significant waiting times reductions for triage categories 3 and 5 (median reductions 5 and 11 minutes respectively). There was an increase in total ED time for triage category 3 (median increase 7 min) and a decrease for categories 4 and 5 (median reduction 14 and 18 min, respectively). Conclusion: ED process redesign based on task analysis and lean thinking approaches can result in improved ED efficiency.