title: The First View Concept:  introduction of industrial flow techniques into emergency medicine organization.
abstract: The number of patients seeking treatment in emergency departments is rising, although many governments are seeking to reduce expenditure on health. Emergency departments must achieve more with the same resources or perform the same functions with fewer resources. Patients demand higher emergency clinical care quality, with low waiting times viewed as a key quality criterion by many patients. The objective of this study was to create an improved working system in emergency departments that cuts patient waiting times for first specialty physician contact. Techniques from industrial flow management were applied to the working process of an emergency department and the concept was named 'First View.' A total of 3269 patient contacts using the First View Concept during a treatment month showed statistical significance. Before introduction, a total 3230 patients in a comparative treatment month had a median waiting time before the first doctor contact of 47.6 min, a first quartile waiting time of 36.1 min, and a third quartile waiting time of 62.7 min. After introduction, 3269 patients had a median waiting time before first specialty physician contact of 11.2 min, a first quartile waiting time of 9.1 min, and a third quartile waiting time of 15.2 min. Industrial flow concepts can achieve significant improvements in emergency department workflows in countries in which sufficient numbers of specialty physicians are available. More attention to the organization of emergency department working processes is needed, especially involving lean management.
authors.affiliation: Emergency Department, Asklepios Hospital Altona, Hamburg, Germany. b.hogan@asklepios.com
authors.forename: Barbara
authors.initials: B
authors.lastname: Hogan
authors.forename: Christoph
authors.initials: C
authors.lastname: Rasche
authors.forename: Andrea Braun
authors.initials: AB
authors.lastname: von Reinersdorff
mesh_terms: D003210:Concept Formation; D017598:Efficiency, Organizational; D004635:Emergency Medicine / Q000458:organization & administration*; D005858:Germany; D005102:Health Expenditures; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand; D006801:Humans; D017146:Models, Organizational; D012189:Retrospective Studies; D014218:Triage; D014850:Waiting Lists; D057188:Workflow