Project NEED: New Efficiency in an Emergency Department

Abstract

It was a cold and windy January day in Montreal. The pediatric emergency department’s (PED) waiting room was full of sick children. Most of them had high fever and were either coughing, crying, or vomiting. The average waiting time to see a doctor was more than 8 hours. Exhausted parents were asking the triage nurse why the waiting time was so long in the brand new emergency department (ED). Couldn’t the nurse understand that their small baby was sick and should have triage priority? As one parent became aggressive, the triage nurse called security. The waiting room looked more like a battlefield.

In the meantime, Dr Dash was at his work station looking around for misplaced laboratory results while teaching and reviewing cases with medical residents. As he finished a case, Dr Dash walked rapidly to take the next patient’s chart…the bin was empty. No new patients were there to be seen. How can this be possible when the recently installed giant screen monitor indicates that there are more than 60 new patients in the waiting room? He asks someone to put patients in the examination rooms and returns to his computer screen. Just then, another doctor walks over to take the chart of a new patient and finds the empty bin. With a desperate look on his face, he turns to Dr Dash and calmly says, “Something’s wrong, we NEED change.”