Clinical process redesign for unplanned arrivals in hospitals.

*Emergency department performance had been deteriorating in NSW Health facilities and at Flinders Medical Centre before a fundamentally new approach involving a redesign method, additional bed capacity and more rigorous hospital performance management was applied. *Redesign was undertaken in over 60 hospitals in New South Wales. *Numerous disconnections and misalignments in the process of care delivery have been uncovered during the diagnostic phase of this redesign. *Solutions addressed the entire patient journey through the hospital, to produce smoother patient flow along the continuum of care. *To achieve a sustained improvement in performance, numerous solutions must be simultaneously implemented in each hospital. *With this multipronged approach, a turnaround in NSW emergency access performance has been achieved in the face of rising demand for services; the improvement has continued over 3 years. *This article reports on our findings from system-wide redesign for unplanned hospital attendances.

Redesigning emergency department patient flows: application of Lean Thinking to health care.

OBJECTIVE: To describe in some detail the methods used and outcome of an application of concepts from Lean Thinking in establishing streams for patient flows in a teaching general hospital ED. METHODS: Detailed understanding was gained through process mapping with staff followed by the identification of value streams (those patients likely to be discharged from the ED, those who were likely to be admitted) and the implementation of a process of seeing those patients that minimized complex queuing in the ED. RESULTS: Streaming had a significant impact on waiting times and total durations of stay in the ED. There was a general flattening of the waiting time across all groups. A slight increase in wait for Triage categories 2 and 3 patients was offset by reductions in wait for Triage category 4 patients. All groups of patients spent significantly less overall time in the department and the average number of patients in the ED at any time decreased. There was a significant reduction in number of patients who do not wait and a slight decrease in access block. CONCLUSIONS: The streaming of patients into groups of patients cared for by a specific team of doctors and nurses, and the minimizing of complex queues in this ED by altering the practices in relation to the function of the Australasian Triage Scale improved patient flow, thereby decreasing potential for overcrowding.

Mental health and alcohol and other drug training for emergency department workers: one solution to help manage increasing demand.

OBJECTIVE: To evaluate a training course for ED staff aiming to improve knowledge and skills in working with mental health and drug/alcohol patients attending EDs. METHODS: Pre- and postcourse questionnaires assessed attitudes and self-ratings of confidence, knowledge and skills in working with these patients. Follow-up interviews assessed if new skills or approaches to patient management had been integrated into daily ED practice. RESULTS: Little change was observed in the course participants' attitudes, although reported attitudes were generally appropriate. Self-ratings of confidence in skills and knowledge showed a significant improvement on all questions following the course. Responses to the follow-up interviews suggest course information has been retained and integrated into practice, especially in conducting triage and other assessments and taking more time to talk to patients. CONCLUSION: The course has led to staff feeling more confident and competent to help mental health or drug/alcohol patients who attend the ED.