title: Effects of multidisciplinary teamwork on lead times and patient flow in the emergency department: a longitudinal interventional cohort study.
abstract: BACKGROUND
  Long waiting times for emergency care are claimed to be caused by overcrowded emergency departments and non-effective working routines. Teamwork has been suggested as a promising solution to these issues. The aim of the present study was to investigate the effects of teamwork in a Swedish emergency department on lead times and patient flow.
  
  
  METHODS
  The study was set in an emergency department of a university hospital where teamwork, a multi-professional team responsible for the whole care process for a group of patients, was introduced. The study has a longitudinal non-randomized intervention study design. Data were collected for five two-week periods during a period of 1.5 years. The first part of the data collection used an ABAB design whereby standard procedure (A) was altered weekly with teamwork (B). Then, three follow-ups were conducted. At last follow-up, teamwork was permanently implemented. The outcome measures were: number of patients handled within teamwork time, time to physician, total visit time and number of patients handled within the 4-hour target.
  
  
  RESULTS
  A total of 1,838 patient visits were studied. The effect on lead times was only evident at the last follow-up. Findings showed that the number of patients handled within teamwork time was almost equal between the different study periods. At the last follow-up, the median time to physician was significantly decreased by 11 minutes (p = 0.0005) compared to the control phase and the total visit time was significantly shorter at last follow-up compared to control phase (p = <0.0001; 39 minutes shorter on average). Finally, the 4-hour target was met in 71% in the last follow-up compared to 59% in the control phase (p = 0.0005).
  
  
  CONCLUSIONS
  Teamwork seems to contribute to the quality improvement of emergency care in terms of small but significant decreases in lead times. However, although efficient work processes such as teamwork are necessary to ensure safe patient care, it is likely not sufficient for bringing about larger decreases in lead times or for meeting the 4-hour target in the emergency department.
authors.affiliation: Department of Medical Sciences, Uppsala University, Uppsala University Hospital, 751 85 Uppsala, Sweden. asa.muntlin@pubcare.uu.se.
authors.forename: Asa
authors.initials: A
authors.lastname: Muntlin Athlin
authors.forename: Ulrica
authors.initials: U
authors.lastname: von Thiele Schwarz
authors.forename: Nasim
authors.initials: N
authors.lastname: Farrohknia
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001509:Bed Occupancy / Q000706:statistics & numerical data; D015331:Cohort Studies; D017598:Efficiency, Organizational; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008330:Management Audit; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data*; D010348:Patient Care Team / Q000458:organization & administration*; D010561:Personnel Staffing and Scheduling / Q000706:statistics & numerical data; D017749:Total Quality Management / Q000458:organization & administration*; D014850:Waiting Lists; D055815:Young Adult