1. Improving patient flow in
Emergency department
By: Sehrish Khakwani, Atinuke Shobowale, &
Matthew Lopez

2. INTRODUCTION
➢ED - Busiest department
➢Throughput refers to emergency department processes that impact patient
flow.
➢“The annual number of ED visits in the United States was 90.3 million in
1996, and that number increased to 129.8 million in 2010.”(Murphy, Barth,
Carlton, Gleason, Cannon 2014)
➢Includes triage, staffing, availability of specialty and diagnostic services,
surgical scheduling and information technology resources.

3. BACKGROUND
➢Increase ED lengths of stay
➢Safe, efficient, quality care in the ED requires frequent and effective
communication.
➢The physical design of individual patient rooms can greatly affect throughput.
➢Emergency department crowding has been identified as a major public health
problem in the United States by the Institute of Medicine.
➢Delays in treatment
➢Long wait times

4. STATEMENT OF PROBLEM
ED crowding is associated with:
➢Poor patient outcomes
➢Longer wait times
➢Inefficient use of staff
➢Decreased patient-centered care
➢Increase of patient not receiving care/ leave without being seen (LWBS)
➢Impacting Revenue

5. PURPOSE
➢To review and analyse the literature concerning ED patient throughput
➢To find techniques to improve ED efficiency

6. SIGNIFICANCE
➢To provide assessment of the throughput of ED patients to identify the gaps in
the system that lead to overcrowding.
➢To pinpoint where organization can focus its resources to optimize better
outcome.
➢To provide other organizations with the information needed to manage
emergency department patient flow.

7. METHODOLOGY
Google Scholar
Research Pro
Search Words:
❏ ED patient flow
❏ Patient boarding
❏ Patient crowding
❏ ED crowding
❏ Lean ED
❏ Fast Track ED
❏ RTT ED
❏ Improving ED patients

8. CONCLUSION
Fast Track
➢ Triage patients according to High Acuity or Low
Acuity
○ A-side
○ B-side
➢ Patient satisfaction with:
○ wait times
○ doctor courtesy
○ nurse courtesy
○ staying informed about delays
Rapid Triage and Treatment (RTT)
➢ RTT Physician and Nurse
○ increase efficiency through improved
communication and teamwork
○ Lower acuity patient placed in RTT area
■ Can be seen in:
● hallway chairs
● 3 small exam rooms
➢ Decreased:
○ Wait times

9. CONCLUSION CONT.
1st - Safety Culture
➢“Every member of the organization must develop an equivalent
commitment to quality” (Zidel, 2011).
➢Top Down
○ Supervise and Guide
➢Bottom Up
○ Implementation

10. CONCLUSION CONT.
2nd- Full look at Problem
➢Creation of Process Improvement Team
○ 15-20 people
○ Multiple disciplines
➢Value Stream Mapping
➢Improvement Meetings
○ Frontline Staff

11. CONCLUSION CONT.
3rd - Slow Implementation
➢Start small
○ How do you eat an elephant?
➢PDCA
○ Continuous improvement
➢Common Goal:
○ Safety
○ Quality

12. REFERENCES
➢ Adamski, P. (2013). Navigating the challenges of patient flow and boarding in hospitals. The Joint Commission Perspectives, 32(6).
➢ Dickson, E. W., Singh, S., Cheung, D. S., Wyatt, C. C., & Nugent, A. S. (2009). Application of lean manufacturing techniques in the
emergency department. The Journal of Emergency Medicine, 37(2), 177–182. http://doi.org/10.1016/j.jemermed.2007.11.108
➢ Hwang, C., Lipman, G., & Kane, M. (2015). Effect of an emergency department fast track on Press-Ganey patient satisfaction scores. Western
Journal of Emergency Medicine, 16(1), 34–38. http://doi.org/10.5811/westjem.2014.11.21768
➢ Joint Commission. (2013). The ‘Patient Flow Standard’ and the 4-hour recommendation. Joint Commission Perspectives, 33(6), 1–4.
Retrieved from http://www.jointcommission.org/assets/1/18/S1-JCP-06-13.pdf
➢ Murrell, K., Offerman, S., & Kauffman, M. (2010). Applying Lean: Implementation of a Rapid Triage and Treatment System. Western Journal of
Emergency Medicine, XII(2), 184–191.
➢ Zidel, T. G. (2011). Lean done right: Achieve and maintain reform in your healthcare organization. Chicago, IL: Health Administration
Press.