title: 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).
  
  
  CONCLUSIONS
  ED process redesign based on task analysis and lean thinking approaches can result in improved ED efficiency.
authors.affiliation: Department of Emergency Medicine, Western Hospital, Private Bag, Footscray, Melbourne, VIC 3011, Australia. Anne-Maree.Kelly@wh.org.au
authors.forename: Anne-Maree
authors.initials: AM
authors.lastname: Kelly
authors.forename: Michael
authors.initials: M
authors.lastname: Bryant
authors.forename: Lisa
authors.initials: L
authors.lastname: Cox
authors.forename: Damien
authors.initials: D
authors.lastname: Jolley
mesh_terms: D000328:Adult; D017598:Efficiency, Organizational; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000706:statistics & numerical data; D006754:Hospital Restructuring / Q000379:methods*; D006784:Hospitals, Teaching / Q000458:organization & administration; D006801:Humans; D007902:Length of Stay; D019982:Organizational Case Studies; D010043:Outcome and Process Assessment, Health Care; D010343:Patient Admission; D010348:Patient Care Team; D010351:Patient Discharge; D013647:Task Performance and Analysis; D013997:Time Factors; D014218:Triage; D006113:United Kingdom; D014739:Victoria