This document discusses strategies to improve patient flow in emergency departments. It notes that ED visits in the US have increased significantly in recent decades, leading to overcrowding issues. The purpose is to review literature on techniques to improve ED efficiency and identify gaps that lead to overcrowding. Some strategies discussed include implementing fast tracks to separate high and low acuity patients, using rapid triage and treatment areas, and applying lean manufacturing principles like continuous process improvement teams. The conclusion emphasizes that successful strategies require a safety culture, fully analyzing the problems, and slowly implementing changes while measuring outcomes.

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.