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Objective: To describe the process and results ofa process redesign based on task analysis andlean thinking approaches aimed at improvingemergency department (ED) efficiency.Methods: Before-and-after study comparing 12-month periods before and after the process redesignfor total episodes of ambulance bypass,waiting times (overall and by triage category) andtotal ED time (overall and by triage category).Time data were analysed using non-parametricmethods.Results: The years were broadly comparable,with the exception that there was an 8.4%increase in total hours of care delivered (a markerof ED workload) in the year after the change.Episodes of ambulance bypass reduced by 55%(120 v 54). There were statistically significantwaiting times reductions for triage categories 3and 5 (median reductions 5 and 11 minutesrespectively). There was an increase in total EDtime for triage category 3 (median increase 7 min)and a decrease for categories 4 and 5 (medianreduction 14 and 18 min, respectively).Conclusion: ED process redesign based on taskanalysis and lean thinking approaches can resultin improved ED efficiency.

Improving emergency department efficiency by patient streaming to outcomes-based teams