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Achieving wait time reduction in the emergency department

Keith A. Willoughby (Department of Finance and Management Science, Edwards School of Business, University of Saskatchewan, Saskatoon, Canada)
Benjamin T.B. Chan (Ontario Health Quality Council, Toronto, Canada)
Marlene Strenger (Royal University Hospital, Saskatoon, Canada)

Leadership in Health Services

ISSN: 1751-1879

Article publication date: 5 October 2010




The purpose of this paper is to provide details on a study to determine the wait time and service time for various emergency department (ED) patient care processes and to apply the science of plan‐do‐study‐act (PDSA) cycles to improve patient flow.


The paper used direct observation to collect patient flow data on 1,728 patients at multiple ED sites in Saskatchewan, Canada. It calculated wait times and services associated with important care processes and then tested, measured and implemented ideas to reduce wait time.


On an average, patients spend nearly five hours in the ED with about one‐half of the visit devoted to waiting for the next required service to take place. Waiting for an inpatient bed, specialist consultation or physician reassessment comprised relatively long wait times. Through the use of visual reminders and standard process worksheets, quality improvement teams were able to achieve large reductions in physician reassessment waiting time. These improvements required minimal materials cost and no additional staff.

Research limitations/implications

The case study featured EDs within a particular Canadian province, so may not be generalizeable to other settings. We only sampled a fraction of ED patients at each facility.

Practical implications

Admitted patients waiting for a hospital bed represent a key contributor to ED congestion. PDSA cycles are a valuable approach to achieving quality improvement in health care.


The paper fulfils an identified need by breaking down an ED patient's waiting time into several high‐level processes. It also applies improvement science to ED patient flow.



Willoughby, K.A., Chan, B.T.B. and Strenger, M. (2010), "Achieving wait time reduction in the emergency department", Leadership in Health Services, Vol. 23 No. 4, pp. 304-319.



Emerald Group Publishing Limited

Copyright © 2010, Emerald Group Publishing Limited

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