Optimizing Emergency Department Front-End Operations

As administrators evaluate potential approaches to improve cost, quality, and throughput efficiencies in the emergency department (ED), front-end operations become an important area of focus. Interventions such as immediate bedding, bedside registration, advanced triage (triage-based care) protocols, physician/practitioner at triage, dedicated fast track service line, tracking systems and whiteboards, wireless communication devices, kiosk self check-in, and personal health record technology (smart cards) have been offered as potential solutions to streamline the front-end processing of ED patients, which becomes crucial during periods of full capacity, crowding, and surges. Although each of these operational improvement strategies has been described in the lay literature, various reports exist in the academic literature about their effect on front-end operations. In this report, we present a review of the current body of academic literature, with the goal of identifying select high-impact front-end operational improvement solutions. [Ann Emerg Med. 2010;55:142-160.]