ABSTRACT
This chapter focuses on those systemic issues that most commonly impact emergency department (ED) operations. It starts at the "front end" of the ED process through to the "back door" and into the community, and discusses key important concepts that make up the blocking and tackling of ED operations. The chapter focuses on the arrival patterns of mental health patients into a large urban medical center, the data proved hospital management's conventional wisdom to be completely wrong. ED staffing was altered to include mental health providers while more open slots for walk-in appointments were provided at the mental health center. Acuity arrival patterns will likely demonstrate when and in what form staffing needs to be provided, and during what hours inpatient demand increases and decreases. The examination of arrival patterns, by hour of day (HOD), day of week (DOW), patient type, and downstream destination, is the key to the performance and cost management of the system.
