Nobody likes waiting for hours in a busy emergency room. Not only do the waits leave many patients angry and frustrated, waits can also cause delays in needed treatments and even result in worse outcomes. How then to speed things up without sacrificing thorough and appropriate care?

The emergency room is one of several hospital departments and is where contact with one of several medical professionals happens. It sounds simple to make the left hand know what the right is doing, but in practice this can be very difficult. However, just about everyone in the health care field is aware of this problem: government is trying to streamline cumbersome and useless requirements; hospital administrators are keen on reducing the number of steps necessary to make admissions from the ER happen and physicians are pushing for less paperwork and more action.

Here are a few examples of process improvement ideas: Instead of having a nurse triage a patient and then the patient is brought back to the ER, have that triage nurse order labs and xrays before the doctor has seen the patient. This may sound crazy-I mean how can a nurse order labs and such without any doctor having even seen the patient? Well, for many (but certainly not all) conditions a premade order sheet might suffice. If you twisted your ankle, an xray can be ordered; if you have burning on urination an urine test can be ordered. You would then see the doctor, labs and xrays already done and be out of the department fairly quickly.

Having dedicated lab and xray technicians helps as well, if the hospital can afford this. These technicians would be primarily responsible for ER patients and only secondarily help with inpatient and outpatient care. Another idea would be to have the admitting physician call in orders directly to the floor, rather than first giving orders to a busy ER nurse, who the would have to in turn call in orders to a floor nurse (who might also be busy).  Fewer steps means more efficiency. Having dedicated rooms or cubicles where patients with minor complaints can be seen rapidly is another good idea. This frees up rooms for patients who will need more time due to more involved or serious complaints. Hiring more medical technicians and or nurse assistants, would free up their more expensive and highly trained RN counterparts to complete more difficult tasks. Ideally, an RN should not be dipping urines or putting on a simple dressing which could be just as easily done by a medical technician. She could then assist the physician with more complex tasks and patient flow would be improved.

Many, many more ideas in the pipeline. Complex medical systems can be modified and streamlined with the goal of improving efficiency without sacrificing quality.