title: Emergency department overcrowding and long wait times: taking a corporate approach to improving patient flow.
abstract: Emergency department (ED) overcrowding and long wait times are major concerns in health systems the world over. Many ED-focused innovations--such as revising staff mix, improving internal processes and exploiting decision-support software--have been implemented to address these complex problems, often with limited success. Beginning in 2008, St. Michael's Hospital in Toronto, which had some of the most challenging ED overcrowding and longest wait times in Ontario, has charted a different course. By taking an organization-wide corporate approach to the challenge of patient flow throughout the hospital, St. Michael's has significantly improved key ED flow metrics for both its admitted and non-admitted patients.
authors.affiliation: Chief of Emergency Medicine at St. Michael's Hospital in Toronto. He also serves as the Associate Dean, Postgraduate Medical Education - Admissions and Evaluation, at the University of Toronto.
authors.forename: Glen
authors.initials: G
authors.lastname: Bandiera
authors.affiliation: Clinical Leader/Manager of the Emergency Department at St. Michael's Hospital.
authors.forename: Karen
authors.initials: K
authors.lastname: Gaunt
authors.affiliation: Executive Vice President and Chief Medical Officer at St. Michael's Hospital, and a professor of Emergency Medicine at the University of Toronto.
authors.forename: Douglas
authors.initials: D
authors.lastname: Sinclair
authors.affiliation: Vice President, Quality, Performance, Information Management and Chief Information Management at St. Michael's Hospital. She oversees the hospital's Patient Access and Flow program.
authors.forename: Anne
authors.initials: A
authors.lastname: Trafford
mesh_terms: D003441:Crowding; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D009864:Ontario; D010343:Patient Admission / Q000592:standards / Q000706:statistics & numerical data; D058996:Quality Improvement / Q000458:organization & administration; D014850:Waiting Lists