title: Qualitative process analysis and modelling of emergency care workflow and interface management: identification of critical process steps.
abstract: OBJECTIVE
  Over the past few years, the number of patients attending emergency services has increased steadily. As a result, emergency departments (EDs) worldwide face frequent crowding, with the risk of reduced treatment quality and impaired patient outcome, patient and staff dissatisfaction and inefficient use of ED resources. A qualitative process analysis and process modelling was used as a method to detect critical process steps in the ED with respect to time and efficiency.
  
  
  METHODS
  The analysis was carried out by independent external process experts. Over a period of 1 week, the complete treatment process of 25 patients was recorded. The monitoring of overall activities, decision points, causalities and interfaces was based on the treatment of 100 additional patients and on interviews with nurses and physicians. The project was closed with the identification of the three most critical process steps and modelling of the standard emergency care process in an event-process chain (EPC).
  
  
  RESULTS
  The most time-crucial steps detected by the analysis were the process of developing a tentative diagnosis, including consultation and advice seeking by inexperienced physicians, the interface to imaging diagnostics and the search of hospital beds for inpatients. The results were visualized by standardized modelling of an event-process chain (EPC).
  
  
  CONCLUSIONS
  The process analysis helped to identify inefficient process steps in the ED. Modelling with EPC is a useful tool to visualize and to understand the complexity of the emergency medical care and to identify key performance indicators for effective quality management.
authors.affiliation: aDepartment of Cardiology, Division of Emergency Medicine, Charité-University Medicine Berlin, Berlin bKarl-Olga Krankenhaus GmbH, Stuttgart cThermofisher Scientific BRAHMS GmbH, Hennigsdorf, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Möckel
authors.forename: Julia
authors.initials: J
authors.lastname: Searle
authors.forename: Ingo
authors.initials: I
authors.lastname: Hüttner
authors.forename: Joern O
authors.initials: JO
authors.lastname: Vollert
mesh_terms: D003441:Crowding; D004635:Emergency Medicine / Q000458:organization & administration; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D004638:Emergency Treatment / Q000592:standards* / Q000639:trends; D005260:Female; D005858:Germany; D006785:Hospitals, University; D006801:Humans; D008297:Male; D017146:Models, Organizational; D009936:Organizational Innovation; D017064:Process Assessment, Health Care; D036301:Qualitative Research; D011787:Quality of Health Care; D014850:Waiting Lists; D057188:Workflow