Implied mechanisms
| Mechanism | Exemplar quotes |
| Patients wait only for those services they need. | ‘We do all the work-up in the unit (RAZ) and then discharge them from the waiting room without them ever getting to the acute side.’ (1124) ‘So that concept of rapid assessment areas: in the past where people were CTAS 1–5, and the 5s waited until the 1s were seen. Now by doing some differential flow you can deal with people and move them in different fashions as they go forward.’ (6109) |
| Variability among patients is reduced, thus increasing efficiency. | ‘All the patients come through you. You tap them. You do their tests. You discharge them. …. And initially we said, you know, you are asking us to see five patients an hour. That’s ridiculous in this complex department. But it turns out that’s exactly what you see. You see five an hour.’ (6103) |
| Provision of standardised (protocol-driven) care enables quicker recovery. | ‘…. Because sometimes people just need a quick med adjustment … So just that ability to be able to do that. As opposed to immersing everyone into the general population of the ED where they often get neglected because, generally speaking, ED staff don’t know how to deal well with mental health patients.’ (8205) |
| Eliminating lag time between multiple steps. | ‘But we did it a little different in that we put a nurse with a physician and a nursing assistant together and they did their assessments together and therefore eliminated, for the most part, a lot of the documentation and history taking redundancies…’ (10102) |
| Promoting efficient use of available space. | ‘…They order tests on you and blood work or whatever and then you go and sit here and have your test from here. Then we put another patient there, so no patient owns a stretcher. … And it allows us to take spaces that would only hold one stretcher or two and make them into five or six spaces and people would actually rather sit up than lay down and rather sit up and watch TV. So by doing that, we changed the flow of patients…’ (5204) |
| Fostering an ethos of efficiency and rapid discharge. | ‘…our hospitalists work in the rapid access unit—where it’s really good towards getting a patient out as efficiently as possible. They (hospitalists) tend to take that mentality with them to their other patients. (name of unit) have a whole team that’s really geared towards making that efficient discharge process, but … that mentality of “let’s get our patients out earlier” tends to spill over to other units, so we’ve seen some benefit in that respect.’ (5211) ‘And they don’t change you into a gown. Because once you’re in a gown, then you think you’re sick. So, then that’s part of what we did to increase the flow in the Emergency Department.’ (5204) |