Objective: To describe the process and results of
a process redesign based on task analysis and
lean thinking approaches aimed at improving
emergency department (ED) efficiency.
Methods: Before-and-after study comparing 12-
month periods before and after the process redesign
for total episodes of ambulance bypass,
waiting times (overall and by triage category) and
total ED time (overall and by triage category).
Time data were analysed using non-parametric
methods.
Results: The years were broadly comparable,
with the exception that there was an 8.4%
increase in total hours of care delivered (a marker
of ED workload) in the year after the change.
Episodes of ambulance bypass reduced by 55%
(120 v 54). There were statistically significant
waiting times reductions for triage categories 3
and 5 (median reductions 5 and 11 minutes
respectively). There was an increase in total ED
time for triage category 3 (median increase 7 min)
and a decrease for categories 4 and 5 (median
reduction 14 and 18 min, respectively).
Conclusion: ED process redesign based on task
analysis and lean thinking approaches can result
in improved ED efficiency.
The Long-Term Effect of an Independent Capacity Protocol on Emergency Department Length of Stay: A before and after Study
