• Byungjoon B J Kim, Theodore R Delbridge, and Dawn B Kendrick.
• Int J Health Care Qual Assur. 2014 Jan 1;27(4):336-46.

PurposeOvercrowding in emergency departments (EDs) leads to longer waiting times and results in higher number of patients leaving the ED without being seen by a physician. EDs need to improve quality for patients' waiting time and length of stay (LoS) from the perspective of process and flow control management. The paper aims to discuss these issues.Design/Methodology/ApproachThe retrospective case study was performed using the computerized ED patient time logs from arrival to discharge between July 1, 2009 and June 30, 2010. Patients were divided into two groups either adult or pediatric with a cutoff age of 18. Patients' characteristics were measured by arrival time periods, waiting times before being seen by a physician, total LoS and acuity levels. A discrete event simulation was applied to the comparison of quality performance measures.FindingsStatistically significant differences were found between the two groups in terms of arrival times, acuity levels, waiting time stratified for various arrival times and acuity levels. The process quality for pediatric patients could be improved by redesign of patient flow management and medical resource.Research Limitations/ImplicationsThe results are limited to a case of one community and ED. This study did not analyze the characteristic of leaving the ED without being seen by a physician.Practical ImplicationsSeparation of pediatric patients from adult patients in an ED can reduce the waiting time before being seen by a physician and the total staying time in the ED for pediatric patients. It can also lessen the chances for pediatric patients to leave the ED without being seen by a physician.Originality/ValueA process and flow control management scheme based on patient group characteristics may improve service quality and lead to a better patient satisfaction in ED.

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