Emergency medicine clinics of North America
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Emerg. Med. Clin. North Am. · Aug 2020
ReviewPatient Assignment Models in the Emergency Department.
Early assignment of patients to specific treatment teams improves length of stay, rate of patients leaving without being seen, patient satisfaction, and resident education. Multiple variations of patient assignment systems exist, including provider-in-triage/team triage, fast-tracks/vertical pathways, and rotational patient assignment. The authors discuss the theory behind patient assignment systems and review potential benefits of specific models of patient assignment found in the current literature.
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Lean engineering is based on a process improvement strategy originally developed at Toyota and has been used in many different industries to maximize efficiency by minimizing waste. Lean improvement projects are frequently instituted in emergency departments in an effort to improve processes and thereby improve patient care. Such projects have been undertaken with success in many emergency departments in order to improve metrics such as door-to-provider time, left without being seen rate, and patient length of stay. By reducing waste in the system, Lean processes aim to maximize efficiency and minimize delay and redundancy to the extent possible.
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Emerg. Med. Clin. North Am. · Aug 2020
ReviewStaffing and Provider Productivity in the Emergency Department.
Staffing and productivity are key concepts to understand when managing an emergency department. Provider productivity is not static, starts out high, and decreases throughout the shift in a stepwise manner. ⋯ Matching capacity to this demand potentially improves overall throughput and efficiency. Once knowledgeable about these factors, we provide a case study to showcase their application.
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Academic emergency departments (EDs) play a vital role in provision of emergency care and contribute to training of resident physicians. Academic EDs also generate innovations and discoveries through clinical research within academic medical centers. However, academic EDs face challenges when initiating operational process improvement efforts because of the medical complexity of patients, academic culture within academic medical centers, and variability in productivity and specialty training of trainees. To optimize operations within academic EDs, it is critical to understand characteristics shared by academic EDs, how to implement process improvement initiatives, trainee impact on ED operations, and how to promote operational research.