Improving Operational Efficiency in the Emergency Department—The Children's Hospital of Michigan Experience

Efficiency, the ability to accomplish a task with a minimum expenditure of time and effort, is essential in any emergency department (ED). Traditional quality of care measures evaluate systems using individual patient data and aggregate these data to identify opportunities for improvement. Operational efficiency (OE) tools examine population-based data and focus on the processes that impact systems performance. This macroperspective facilitates the delivery of the greatest care to the greatest number of patients. In view of the challenges faced in measuring quality of care to a population, it is imperative to accept that OE is a critical driver in determining quality of care. This article will describe the OE model used at the Children's Hospital of Michigan to change an existing system in a tertiary pediatric ED. Our work resulted in reducing ED admission time by 83%, the left without being seen rate by 91%, and the ED length of stay by 48%; improved the door-to-doctor time; and eliminated waiting room deaths.