Clinical process redesign for unplanned arrivals in hospitals.

*Emergency department performance had been deteriorating in NSW Health facilities and at Flinders Medical Centre before a fundamentally new approach involving a redesign method, additional bed capacity and more rigorous hospital performance management was applied. *Redesign was undertaken in over 60 hospitals in New South Wales. *Numerous disconnections and misalignments in the process of care delivery have been uncovered during the diagnostic phase of this redesign.

Redesigning emergency department patient flows: application of Lean Thinking to health care.

Objective: To describe in some detail the methods used and outcome of an application of concepts from Lean Thinking in establishing streams for patient flows in a teaching general hospital ED.

Methods: Detailed understanding was gained through process mapping with staff followed by the identification of value streams (those patients likely to be discharged from the ED, those who were likely to be admitted) and the implementation of a process of seeing those patients that minimized complex queuing in the ED.

Results: Streaming had a significant impact on waiting times and total durations of stay in the ED.

Mental health and alcohol and other drug training for emergency department workers: one solution to help manage increasing demand.

Objective: To evaluate a training course for ED staff aiming to improve knowledge and skills in working with mental health and drug/alcohol patients attending EDs.

Methods: Pre- and postcourse questionnaires assessed attitudes and self-ratings of confidence, knowledge and skills in working with these patients. Follow-up interviews assessed if new skills or approaches to patient management had been integrated into daily ED practice.