Aims We piloted a new paediatric ED system in preparation for moving to a new hospital with a significantly larger ED to assess the effect on patient flow through the department. This involved changing from the current system – minors and a MAU admitting only medical patients triage category 2 and 3 – to a majors and minors system. Anecdotal evidence suggested the MAU system resulted in inappropriately long patient waiting times. We wanted to assess and review the patient journey through the ED. We aimed to identify potential roadblocks in the patient flow through the department, and how these could be removed. We aimed to make patient flow more ergonomic, and improve collaboration between the emergency department and other hospital specialties.

Method All ED attendances over two periods were reviewed. From 19.01.15–15.02.15 data was collected via a data monitoring system. Data was presented using unscheduled care target breeches, and the following identified sections of the patient journey:

• Triage to MAU arrival time

• Triage to decision to admit time

• Decision to admit to bed request time

• Patient ready to time left MAU

The following changes were then implemented and data re-collected from 02.03.15–29.03.15:

• Medical and surgical patients category 2 and 3 would go to majors

• Majors and Minors would have ED consultant supervision

• Introducing a Nurse Coordinator to facilitate patient flow

• Creating a bed-booking system

Results With implementation of the majors system, unscheduled care targets improved by 30%, and there was a significant reduction in the length of time of all “roadblocks” identified in the patient ED journey. This was achieved despite a 16% increase in MAU/Majors attendance, and an overall increase in ED attendances of 10% between the two time periods. Despite this there was no significant increase in overall hospital admission rates.

Conclusions By implementing the changes in the ED system in this pilot we demonstrated significant improvement in departmental efficiency and improved patient flow through the department. This was achieved through collaborative working with both medical/surgical specialties and promoting early clinical decision making.