Journal Review - Rapid process redesign in a university-based emergency department: Decreasing waiting time intervals and improving patient satisfaction
Spaite DW, Bartholomeaux F, Guisto J, et al. Rapid process redesign in a university-based emergency department: Decreasing waiting time intervals and improving patient satisfaction. Ann Emerg Med 2002; 29:168-177.
A process improvement team can dramatically improve patient flow and reduce delays in the ED, says this study from the University Medical Center in Tucson, AZ. Several process improvement teams gave the following recommendations for changes that were implemented over two months in 1998:
• changing nursing responsibility from five or six beds per nurse to no more than four beds per nurse, to increase availability of nurses;
• placing similar patients together. "By redistributing nursing resources, less ill patients were not held hostage to sicker ones and could be more efficiently treated," say the researchers;
• creating a new 24-hour clerical position to separate order processing from communication tasks;
• rearranging the triage process so that the triage nurse does a brief assessment, identifies a room, radios the charge nurse and registration clerk of the patient’s destination, then places the patient in a room;
• changing the process of obtaining and ordering radiographs, by implementing electronic transcription of orders, placing a film printer in the ED radiology suite, and increasing radiology staffing.
As a result of these and other changes, after a six-month period, median waiting room time decreased from 31 minutes to four minutes, and throughput times decreased from four hours and 21 minutes to two hours and 55 minutes. The researchers note that these improvements took place despite increase in ED volume over the previous year. However, they note that there must be commitment and support from the highest levels of the hospital to succeed. "The absence of this major focus would doom an undertaking such as this to failure," they write.
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