title: Clinical process redesign for unplanned arrivals in hospitals.
abstract: *Emergency department performance had been deteriorating in NSW Health facilities and at Flinders Medical Centre before a fundamentally new approach involving a redesign method, additional bed capacity and more rigorous hospital performance management was applied. *Redesign was undertaken in over 60 hospitals in New South Wales. *Numerous disconnections and misalignments in the process of care delivery have been uncovered during the diagnostic phase of this redesign. *Solutions addressed the entire patient journey through the hospital, to produce smoother patient flow along the continuum of care. *To achieve a sustained improvement in performance, numerous solutions must be simultaneously implemented in each hospital. *With this multipronged approach, a turnaround in NSW emergency access performance has been achieved in the face of rising demand for services; the improvement has continued over 3 years. *This article reports on our findings from system-wide redesign for unplanned hospital attendances.
authors.affiliation: Health Services Performance Improvement, NSW Health, Sydney, NSW, Australia.
authors.forename: Tony J
authors.initials: TJ
authors.lastname: O'Connell
authors.forename: Jane E
authors.initials: JE
authors.lastname: Bassham
authors.forename: Rod O
authors.initials: RO
authors.lastname: Bishop
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Clarke
authors.forename: Carolyn J
authors.initials: CJ
authors.lastname: Hullick
authors.forename: Diane L
authors.initials: DL
authors.lastname: King
authors.forename: Carmel L
authors.initials: CL
authors.lastname: Peek
authors.forename: Raj
authors.initials: R
authors.lastname: Verma
authors.forename: David I
authors.initials: DI
authors.lastname: Ben-Tovim
authors.forename: Katherine M
authors.initials: KM
authors.lastname: McGrath
mesh_terms: D003266:Continuity of Patient Care; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D006779:Hospitals, Public / Q000458:organization & administration; D006801:Humans; D009313:National Health Programs / Q000458:organization & administration; D009517:New South Wales; D009936:Organizational Innovation; D010043:Outcome and Process Assessment, Health Care; D010346:Patient Care Management / Q000458:organization & administration* / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data