We are no longer accepting new teams in this Community. If you have questions, please contact impact@ihi.org.

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The Challenge
Emergency departments (EDs) are critical to our patients and to our communities. But too often “Friday Night in the Emergency Department” conjures up the image of a long wait or a chaotic scene. This image might be a bit exaggerated, but too often both our patients and our health care workers experience frustration in the ED.

In June 2006, the Institute of Medicine released a report titled “The Future of Emergency Care in the United States Health System” that included a key finding: many emergency departments and trauma centers are overcrowded. Delays that result from ED overcrowding contribute to poor medical outcomes, frustrated and unhappy patients, increased cost from waste and rework, potential harm, and stress for both patients and caregivers. Despite tremendous efforts, health care professionals are continuously challenged to provide care that is safe, effective, timely, efficient, and patient-centered.

The Solution
Reducing delays is critical to improving other aspects of care in emergency departments, including safety, patient and staff satisfaction, and cost control. In certain times and situations, solutions that focus on individuals parts — such as bypassing triage, bedside registration, ancillary services, eliminating the waiting room, fast tracks, and nurse-initiated orders — have proven effective. However, they have not often resulted in optimizing the entire emergency department.

In this Community, organizations will focus on a systems approach to optimizing flow. The approach is based on demand capacity management, enhanced patient intake and optimization of key patient segments. It allows for interventions tailored to the demand, circumstances, and key bottlenecks of individual departments. Concepts from the theory of constraints, queuing theory, managing variation and lean production will guide the work. Participants will be able to take advantage of operational assessment tools.