Flow strategies cover processes in and out of ED.

With changes in place only about six months, Cincinnati Children's Hospital Medical Center, compared the May-July period door-to-doc times and found they had dropped from 61 minutes in 2008 to 45 minutes in 2009. The ED manager interfaces with the hospital's director of patient flow, and they have initiated new processes inside and outside the department: Nurses have been placed at the ED entrance to take a "quick look" at patients. Handoffs are handled via fax, so ED nurses no longer have to track down their inpatient counterparts for a telephone conversation. Mathematical formulas have been created to predict admissions and discharges.