title: Retrospective analysis of quality improvement throughput measures at a high-volume community emergency department.
abstract: OBJECTIVE
  To assess the effect of having a physician or physician's assistant (PA) as patients' first point of contact in our emergency department (ED) on the rate of leaving without being seen (LWBS) and wait time.
  
  
  METHODS
  In before and after intervention conducted in the ED at a 265-bed community hospital, data were collected on all patients presenting to the ED during a 70-month period. A physician or PA was stationed in triage 16 hr a day. The screening process included measurement of vital signs, a brief history and physical examination, and computerized physician order entry.
  
  
  RESULTS
  During the study period, volume increased from 86,000 to 102,000 patients per year. Monthly averages for ED visits increased 16%, admissions increased 5%, and ambulance visits increased 18%. The rate of LWBS decreased from 3.1% to 1.7%. Door-to-doctor time decreased by 14 min.
  
  
  CONCLUSIONS
  Despite an increase in patient census, the LWBS rate and door-to-doctor time decreased. This study of one solution to the issue of ED crowding demonstrates how a process redesign can lead to successful changes in throughput metrics.
authors.forename: Andrew
authors.initials: A
authors.lastname: Milsten
authors.forename: Joel
authors.initials: J
authors.lastname: Klein
authors.forename: Qin
authors.initials: Q
authors.lastname: Liu
authors.forename: Neel
authors.initials: N
authors.lastname: Vibhakar
authors.forename: Lawrence
authors.initials: L
authors.lastname: Linder
mesh_terms: D003441:Crowding; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000706:statistics & numerical data*; D006764:Hospitals, Community; D006801:Humans; D007902:Length of Stay; D010343:Patient Admission; D010823:Physician Assistants; D010820:Physicians; D058996:Quality Improvement / Q000458:organization & administration*; D012189:Retrospective Studies; D013997:Time Factors; D014218:Triage / Q000458:organization & administration* / Q000706:statistics & numerical data*
keywords: ED throughput; crowding; physician triage