Improving emergency department efficiency by patient streaming to outcomes-based teams
Open accessAbstract
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 claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Lean implementation in reviewed emergency departments was associated with decreased waiting time to be seen.
“Decreased waiting time to be seen [ 72 ] [ 77 ] [ 79 ] [ 80 ] [ 81 ]”
From Lean Thinking in Emergency Departments: A Critical Review (2011) · cites this paper as [79]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Lean Thinking—Banish Waste and Create Wealth in your Corporation
Womack, J. P., & Jones, D. T. (1997) · Journal of the Operational Research Society · doi:10.1057/palgrave.jors.2600967 · Cited by 2,122 · see citing works
Redesigning emergency department patient flows: application of Lean thinking to health care
King, D. L., Ben‐Tovim, D. I., & Bassham, J. (2006) · Emergency Medicine Australasia · doi:10.1111/j.1742-6723.2006.00872.x · Cited by 279 · see citing works
Fatovich, D. M. (2005) · Emergency Medicine Journal · doi:10.1136/emj.2004.018002 · Cited by 276 · see citing works
Emergency department length of stay independently predicts excess inpatient length of stay
Liew, D., Liew, D., & Kennedy, M. P. (2003) · The Medical Journal of Australia · doi:10.5694/j.1326-5377.2003.tb05676.x · Cited by 262 · see citing works
Emergency department crowding: A point in time
Schneider, S. M., Gallery, M. E., Schafermeyer, R. W., et al. (2003) · Annals of Emergency Medicine · doi:10.1067/mem.2003.258 · Cited by 211 · see citing works
Richardson, D. B. (2002) · The Medical Journal of Australia · doi:10.5694/j.1326-5377.2002.tb04917.x · Cited by 197 · see citing works
Emergency department contributors to ambulance diversion: A quantitative analysis
Schull, M. J., Lazier, K., Vermeulen, M. J., Mawhinney, S., & Morrison, L. J. (2003) · Annals of Emergency Medicine · doi:10.1067/mem.2003.23 · Cited by 176 · see citing works
Emergency department overcrowding and ambulance transport delays for patients with chest pain.
Schull, M. J., Morrison, L. J., Vermeulen, M. J., & Redelmeier, D. A. (2003) · Europe PMC (PubMed Central) · Cited by 167 · see citing works
Entry overload, emergency department overcrowding, and ambulance bypass
Fatovich, D. M., & Hirsch, R. L. (2003) · Emergency Medicine Journal · doi:10.1136/emj.20.5.406 · Cited by 153 · see citing works
Dunn, R. (2003) · Emergency Medicine Australasia · doi:10.1046/j.1442-2026.2003.00441.x · Cited by 93 · see citing works
Approach to decreasing emergency department ambulance diversion hours
Vilke, G. M., Brown, L., Skogland, P., et al. (2004) · Journal of Emergency Medicine · doi:10.1016/j.jemermed.2003.07.003 · Cited by 54 · see citing works
Making see and treat work for patients and staff
Parker, L. (2004) · Emergency Nurse · doi:10.7748/en.11.9.16.s13 · Cited by 13 · see citing works
Emergency Department Overcrowding: What Is Our Response to the "New Normal"?
Fernandes, C. M. B. (2003) · Academic Emergency Medicine · doi:10.1111/j.1553-2712.2003.tb00580.x · Cited by 13 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Lean Thinking in Emergency Departments: A Critical Review
Holden, R. J. (2011) · Annals of Emergency Medicine · doi:10.1016/j.annemergmed.2010.08.001 · Cited by 516 · see citing works
Use of Lean in the emergency department: a case series of 4 hospitals
Dickson, E. W., Anguelov, Z., Vetterick, D., Eller, A., & Singh, S. (2009) · Annals of Emergency Medicine · doi:10.1016/j.annemergmed.2009.03.024 · Cited by 244 · see citing works
Streaming by case complexity: evaluation of a model for emergency department fast track
Ieraci, S., Digiusto, E., Sonntag, P., Dann, L., & Fox, D. (2008) · Emergency Medicine Australasia · doi:10.1111/j.1742-6723.2008.01087.x · Cited by 106 · see citing works
A simple tool to predict admission at the time of triage
Cameron, A., Rodgers, K., Ireland, A., Jamdar, R., & McKay, G. A. (2015) · Emergency Medicine Journal · doi:10.1136/emermed-2013-203200 · Cited by 99 · see citing works
A case study of kanban implementation within the pharmaceutical supply chain
Papalexi, M., Bamford, D., & Dehe, B. (2016) · International Journal of Logistics Research and Applications · doi:10.1080/13675567.2015.1075478 · Cited by 58 · see citing works
Barak-Corren, Y., Israelit, S. H., & Reis, B. Y. (2017) · Emergency Medicine Journal · doi:10.1136/emermed-2014-203819 · Cited by 52 · see citing works
The sustainable improvement of patient flow in an emergency treatment centre using Lean
Dickson, E. W., Anguelov, Z., Bott, P., Nugent, A., Walz, D., & Singh, S. (2008) · International Journal of Six Sigma and Competitive Advantage · doi:10.1504/ijssca.2008.021841 · Cited by 15 · see citing works
- Authors
- Kelly, A.-M., Bryant, M., Cox, L., & Jolley, D.
- Affiliations
- Western Hospital (AU)
- ORCID
- Kelly, Anne-Maree
- Venue
- Australian Health Review
- Publisher
- CSIRO Publishing
- Published
- 2007-02-01
- Volume
- 31
- Issue
- 1
- Pages
- 16-21
- ISSN
- 0156-5788 (ISSN-L)
- 1449-8944
- OpenAlex
- W2089364879
- Cited by
- 124
- References
- 13
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 5 · 2023: 3 · 2022: 2 · 2021: 5 · 2020: 6 · 2019: 9 · 2018: 6 · 2017: 3 · 2016: 9 · 2015: 16 · 2014: 14 · 2013: 5 · 2012: 3
- FWCI
- 7.17
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Australian Health Review (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
- Health Sciences › Health Professions › Emergency Medical Services › Healthcare Operations and Scheduling Optimization
- Health Sciences › Health Professions › Health Information Management › Healthcare Quality and Management
- Keywords
- emergency department efficiency, process redesign, task analysis, lean thinking, waiting time, triage categories
- MeSH terms
- Adult, Emergency Service, Hospital, United Kingdom, Hospital Restructuring, Hospitals, Teaching, Humans, Length of Stay, Outcome and Process Assessment, Health Care, Patient Admission, Patient Care Team, Patient Discharge, Task Performance and Analysis, Time Factors, Triage, Victoria, Efficiency, Organizational, Organizational Case Studies
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
