Research Article Minimizing ED Waiting Times and Improving Patient Flow and Experience of Care Assaad Sayah, 1 Loni Rogers, 2,3 Karthik Devarajan, 2,3 Lisa Kingsley-Rocker, 1 and Luis F. Lobon 1 1 Department of Emergency Medicine, Cambridge Health Alliance, 1493 Cambridge Street, Cambridge, MA 02139, USA 2 Tufs University School of Medicine, Boston, MA, USA 3 Heller School of Social Policy and Management, Brandeis University, Waltham, MA, USA Correspondence should be addressed to Assaad Sayah; asayah@cha.harvard.edu 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. Tis 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. Trough a comprehensive and collaborative process, we reengineered the emergency patient experience from arrival to departure. Te ED operational changes have had a signifcant 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 specifc quality core measures improved from a mean of 71% to 97%. Te mean rate of ED patients that lef without being seen (LWBS) dropped from 4.1% to 0.9%. Improving ED operational efciency allowed us to accommodate increasing volume while improving the quality of care and satisfaction of the ED patients with minimal additional resources, space, or stafng. 1. Introduction At the intersection of diagnosis, treatment, and immense patient volumes, the Emergency Department (ED) is arguably the most operationally complex clinical setting of the modern hospital. Unfortunately, it may also be the least understood. From 1995 to 2009, annual ED visits in the US increased by 41% (from 96.5 million to 136.1 million). At the same time, however, the number of hospital Emergency Departments decreased by 27% (from 2,446 to 1,779) [1–3]. Long ED waiting and turnaround times have been shown to decrease both quality outcomes and patient satisfaction [4–6]. Among US Emergency Departments in 2010, only 31% achieved the appropriate triage targets for their patients, while only 48% admitted their patients within 6 hours [7]. Like many other EDs around the country, Te Cambridge Hospital (TCH) ED sufered from similar patient fow issues including long waits, inefcient processes, and poor patient satisfaction. Tis paper describes the changes implemented at TCH and the resulting impact on quality, patient fow, and experience of care. 2. Methods We conducted a pre- and postintervention analysis to assess the impact of a patient fow improvement project at TCH, an academic public institution located in Cambridge Mas- sachusetts with an annual ED census of approximately 30,000 patients. Every patient that entered the ED from January 2005 to December 2011 was included as a study participant. Te protocol received an Exempt Status from the Cambridge Health Alliance IRB. In mid-2006, we committed to a system-wide process improvement project aimed at optimizing the ED patient experience by expediting throughput and fow. Te Patient Hindawi Publishing Corporation Emergency Medicine International Volume 2014, Article ID 981472, 8 pages http://dx.doi.org/10.1155/2014/981472