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How Improving the Flow of the Least Sick Patients in the ED Resulted in Overall Gains for All Patients


Despite requiring only minimal care, patients with lower acuity presentations contribute disproportionately to ED congestion, and to the resultant decrease in quality of care and resources available for all patients. A rapid improvement event was organized by frontline workers to rapidly and drastically alter processes of care, which led to the creation of the RME unit. The RME unit was created by re-purposing existing resources and re-assigning one physician and one nurse towards the assessment, treatment, and discharge of non-complex patients. Evaluation revealed that patients seen in the RME unit saw their median PIA and LOS times decrease from 98min to 70min (a 27% decrease) and from 165min to 130min (a 21% decrease) from baseline, respectively. Additionally, wait times of patients with higher acuity presentations seen in the ED were not affected adversely despite increases in volumes.


Lucas Chartier, Timothy Josephson
Team membersJason Dickson, Jill Smirnis, Kathy Bates, Meredith Kuipers
Term of projectMarch 2014 – December 2015


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