Mayer T, Jensen K
Gulf Breeze, Florida: Fire Starter Publishing; 2009

This book presents a proven methodology for improving patient flow that helps hospitals maximize the "Three E's": efficiency, effectiveness, and execution. Also discussed are ways to engage physicians in the flow process, and how to apply the principles of better patient flow to the emergency department, inpatient experiences, and surgical processes.

Krupka DC, Sandberg WS. Operating room design and its impact on operating room economics. Current Opinions on Anaesthesiology. 2006 Apr;19(2):185-191.

Operating rooms are high-cost/high-revenue environments. In an era of rising costs and declining reimbursement, it is essential to optimize the effectiveness of the operating room suite, maximizing throughput of profitable cases while minimizing the costs of necessary, but unprofitable, procedures.

Harders M, Malangoni MA, Weight S, Sidhu T. Improving operating room efficiency through process redesign. Surgery. 2006 Oct;140(4):509-514; discussion 514-516.

Operating rooms (ORs) are important resources for patient care and revenue, yet a significant portion of OR time is taken up by nonoperative activities. The authors of this study hypothesized that redesigning the process that occurs between operations would lead to a decrease in nonoperative time.

Brixey JJ, Tang Z, Robinson DJ, et al. Interruptions in a level one trauma center: A case study. International Journal of Medical Informatics. 2007 Jun 12; [Epub ahead of print].

This article provides an enhanced understanding of interruptions in workflow in the emergency department (ED), and describes work constraints and the need for interventions to manage interruptions that may contribute to medical errors. The study found that most interruptions were attributable to people, pagers, and telephones. The physical environment (physical design and unavailability of supplies) also contributed to interruptions in workflow.

Wilson MJ, Nguyen K. Bursting at the Seams: Improving Patient Flow to Help America’s Emergency Departments. Urgent Matters Learning Network White Paper; September 2004.

Across America, hospital emergency departments (EDs) are in crisis. For many American communities, the local hospital ED has become the linchpin of the health care safety net. With their legal obligation to see all patients at all times, and with more people than ever seeking their services, EDs nationwide are bursting at the seams.

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Csikszentmihalyi M.
New York, New York: HarperCollins Publishers; 1990

You have heard about how a musician loses herself in her music, how a painter becomes one with the process of painting. In work, sport, conversation or hobby, you have experienced, yourself, the suspension of time, the freedom of complete absorption in activity. This is "flow," an experience that is at once demanding and rewarding. The author uses case studies, controlled experiments, and numerous references to historical figures, philosophers and scientists to prove the point that flow is a singularly productive and desirable state. But the implications for its application to society are what make the book revolutionary.

Solberg LI, Asplin BR, Weinick RM, Magid DJ. Emergency department crowding: Consensus development of potential measures. Annals of Emergency Medicine. 2003;42(6):824-834.

The authors of this study identified measures of emergency department (ED) and hospital workflow that would be of value in understanding, monitoring, and managing crowding. A national group of 74 experts developed 113 potential measures using a conceptual model of ED crowding that segmented the measures into input, throughput, and output categories. Ten investigators then used group consensus methods to revise and consolidate them into a refined set of 30 measures that were rated by all 74 experts.

Schafermeyer RW, Asplin BR. Hospital and emergency department crowding in the United States. Emergency Medicine. 2003;15(1):22-27.

Inpatient boarding is the most frequently cited reason for emergency department (ED) crowding in US hospitals. Many hospitals also struggle with a shortage of health care professionals, particularly registered nurses. This paper provides a brief overview of hospital and ED crowding in the US and outlines future directions in the search for solutions, including several policy issues that must be addressed to alleviate crowding over the long term.

Liew D, Kennedy MP. Emergency department length of stay independently predicts inpatient length of stay. Medical Journal of Australia. 2003;179(10):524-526.

This article describes a study whose purpose was to examine the association between emergency department length of stay (EDLOS) and inpatient length of stay (IPLOS).

Lewandrowski K. How the clinical laboratory and the emergency department can work together to move patients through quickly. Clinical Leadership and Management Review. 2004;18(3):155-159.

The emergency departments (ED) at many medical centers are experiencing increased crowding and prolonged ED patient length of stay. During periods of heavy patient volume, the ED may go on divert status and be unable to care for new patients except for life-threatening illness. The authors describe the implementation of an ED satellite laboratory (kiosk) at Massachusetts General Hospital as part of a larger interdepartmental effort to improve ED operations.