efficiency in the ED

see also:

• administrative aspects of Emergency Medicine in Australia
• ED fast track and streaming
• ED overcrowding and bed access block
• queue theory
• clinical handover

• efficiency of ED's is critical for safe and high quality timely patient care in an ever strained system

• remove faulty equipment
• ensure the needed equipment is clearly visible, sorted, functioning and maintained
• remove extraneous, unused equipment, signs, features from the environment
• standardise processes
• reduce frustrations, reduce repeated annoying work practices / equipment malfunction or poor design

• long waiting times are due to variation in both demand for work and variation in our capacity to deal with work, and as most of the variation in demand is predictable, it is our controllable artificial variations which potentially contribute most to the queues
• reduced variability is important in improving efficiency
  • natural variation
    • eg. times patient present to ED
  • artificial variation
    • scheduling of services, ward rounds, clinical handover, or discharge times, etc
    • staff leave planning
    • ordering of investigations for a given presentation
    • hours of work
    • prioritisation of care
  • special cause variation
    • flu epidemic, external disaster, extreme weather events
    • an uncommon clinical case with unusual care needs
• chart the variations daily or weekly avoiding aggregated data (as this may hide patterns) for a given process to identify poorly controlled controllable variation
  • then determine if the variation is mainly natural or artificial using process mapping, journey times, etc
• standardise processes
• match staffing to demand
• if special, unpredictable extremes of variation occur, as these are generally the result of external factors, the general advice is to target management of those extremes rather than trying to change the system which may otherwise be functioning well