title: Rapid process redesign in a university-based emergency department: decreasing waiting time intervals and improving patient satisfaction.
abstract: Academic emergency departments are traditionally associated with inefficiency and long waits. The academic medical model presents unique barriers to system changes. Several non-university-based EDs have undertaken process redesign, with significant decreases in patient waiting time intervals. This is the presentation of a rapid process redesign in a university-based ED to reduce waiting time intervals. We present the application of a process-improvement team approach to evaluate and redesign patient flow. As a result of this effort, the median waiting room time interval (triage to patient room) decreased from 31 minutes in January 1998 to 4 minutes in July 1998. ED throughput times also decreased, from 4 hours, 21 minutes in January 1998 to 2 hours, 55 minutes in July 1998. Urgent care waiting room time intervals decreased from 52 minutes to 7 minutes and throughput times from 2 hours, 9 minutes to 1 hour, 10 minutes. Patient satisfaction evaluations by an independent institute demonstrated dramatic improvement and establishment of a new benchmark for academic EDs. Process redesign is possible in a busy, complex, tertiary-care ED, with decreases in waiting time intervals and improvement in patient satisfaction. Major sustained support from top-level hospital administrators and physician leadership are fundamental prerequisites. With these in place, a process improvement team approach for evaluating and redesigning the patient care system can be successful.
authors.affiliation: Arizona Emergency Medicine Research Center, the Department of Emergency Medicine, College of Medicine, University of Arizona, Tucson, AZ 85724-5057, USA. dan@aemrc.arizona.edu
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Spaite
authors.forename: Fran
authors.initials: F
authors.lastname: Bartholomeaux
authors.forename: John
authors.initials: J
authors.lastname: Guisto
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Lindberg
authors.forename: Becky
authors.initials: B
authors.lastname: Hull
authors.forename: Alicia
authors.initials: A
authors.lastname: Eyherabide
authors.forename: Sally
authors.initials: S
authors.lastname: Lanyon
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Criss
authors.forename: Terence D
authors.initials: TD
authors.lastname: Valenzuela
authors.forename: Carol
authors.initials: C
authors.lastname: Conroy
mesh_terms: D000046:Academic Medical Centers / Q000458:organization & administration*; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D006749:Hospital Design and Construction; D006801:Humans; D017060:Patient Satisfaction; D011795:Surveys and Questionnaires; D013997:Time Factors