• Fuad Basis, Shimon Pollack, Leora Utits, and Moshe Michaelson.
• Department of Emergency Medicine, Rambam Medical Center, Haifa, Israel. f_basis@rambam.health.gov.il
• Eur J Emerg Med. 2005 Apr 1; 12 (2): 57-62.

BackgroundRambam Medical Centre is a 950-bed referral hospital, containing 34 beds in the Emergency Department (ED). The arrangement of the ED was based on two separate units: trauma and medical. Patient evaluation lasted many hours, with an abuse of consultants, laboratory and imaging services.ObjectiveTo describe the improvement of patient management in our ED by changing working patterns according to emergency medicine guidelines.MethodsThe trauma and medical units were combined into a one-unit ED, managed by one director and two specialists in emergency medicine. The goal of the ED was defined as the treatment and triage of patients towards discharge or admission in the minimal time needed. New protocols for clinical evaluation, blood and imaging tests, consultation facilities and pain management were implemented according to emergency medicine practice. Once a decision for admission is made, a computerized program assigns the patient to the appropriate ward.ResultsThere was a dramatic reduction (44%) in the time needed for patient evaluation. The number of patients waiting more than 4 h and 8 h for admission was reduced significantly (11 versus 38% and 1 versus 24%, respectively). The total number of blood tests was reduced by 45%, and the number of blood and urine cultures by 81 and 87%, respectively. Two years after the change, the ED won first place in patient satisfaction screening.ConclusionsBy changing work methods according to emergency medicine guidelines, and by using protocols written for emergency medicine, a significant improvement in our duties as an ED was achieved. The backing of the hospital management helped to implement the changes, which led to the functional improvement.

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