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Emergency Medicine International
Volume 2014 (2014), Article ID 981472, 8 pages
Research Article

Minimizing ED Waiting Times and Improving Patient Flow and Experience of Care

1Department of Emergency Medicine, Cambridge Health Alliance, 1493 Cambridge Street, Cambridge, MA 02139, USA
2Tufts University School of Medicine, Boston, MA, USA
3Heller School of Social Policy and Management, Brandeis University, Waltham, MA, USA

Received 27 December 2013; Revised 1 March 2014; Accepted 6 March 2014; Published 14 April 2014

Academic Editor: Chak W. Kam

Copyright © 2014 Assaad Sayah et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


We conducted a pre- and postintervention analysis to assess the impact of a process improvement project at the Cambridge Hospital ED. Through a comprehensive and collaborative process, we reengineered the emergency patient experience from arrival to departure. The ED operational changes have had a significant positive impact on all measured metrics. Ambulance diversion decreased from a mean of 148 hours per quarter before changes in July 2006 to 0 hours since April 2007. ED total length of stay decreased from a mean of 204 minutes before the changes to 132 minutes. Press Ganey patient satisfaction scores rose from the 12th percentile to the 59th percentile. ED patient volume grew by 11%, from a mean of 7,221 patients per quarter to 8,044 patients per quarter. Compliance with ED specific quality core measures improved from a mean of 71% to 97%. The mean rate of ED patients that left without being seen (LWBS) dropped from 4.1% to 0.9%. Improving ED operational efficiency allowed us to accommodate increasing volume while improving the quality of care and satisfaction of the ED patients with minimal additional resources, space, or staffing.