Background and Objectives: The provision of emergency care is globally recognized as among the most difficult and challenging elements of any healthcare system. Hamad Medical Corporation (HMC) was facing increasing pressure to introduce initiatives to significantly ease problems with congestion at Hamad General Hospital's (HGH) Emergency Department (ED). This ED is one of the busiest in the world, with an average daily census of 1,500 patients. Due to the large number of patients, fragmented design and inappropriate placement and distribution of resources, all previous attempts at decongesting the ED and improving patient flow were unsuccessful. HGH leaders knew from internal data that the large volume of the male low-acuity patients represented approximately 70% of total ED patients, and were the main reason for congestion and crowding. Therefore, targeting this group would bring about the most significant impact. Methods: Data were studied in order to predict the number of patients who would fit the low-acuity criteria. This study confirmed that up to 70% of all ED patients fell within the low-acuity criteria. Lean process mapping was conducted to determine the current state of patient flow, processes, and practices in the male low-acuity areas of the ED. The impact of the existing fragmented facility design was also studied. Detailed analysis of a patient's journey from arrival to disposition was undertaken. Results: The process mapping confirmed many unacceptable variations when managing low-acuity cases in the ED and it was evident new design and processes were required. A 'See and Treat' service was opened on 7 March 2010 resulting in: reduction in door-to-door transit time, reduction in adverse events and complaints, improvements in maintaining patients' privacy and confidentiality, more appropriate resource utilization, routine referring orthopedic team, better pathway for x-ray, pharmacy and cashier, and new documentation to support efficiency. Conclusions: We believe that the remarkable success of the 'See and Treat' service in such a challenging and unique department as ours is a clear evidence that it should be acknowledged as a benchmark for best practice for the provision of efficient and safe patient care in an emergency department, particularly when managing high-volume, low-acuity presentations.


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