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J Emerg Med. 2018 Aug;55(2):269-277. doi: 10.1016/j.jemermed.2018.04.054. Epub 2018 Jun 6.

Grow the Pie: Interdepartmental Cooperation as a Method for Achieving Operational Efficiency in an Emergency Department.

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Department of Emergency Medicine, UC San Diego Health System, San Diego, California.
Perioperative and Imaging Services, UC San Diego Health System, San Diego, California.
Budgeting and Financial Forecasting, UC San Diego Health System, San Diego, California.



Despite sufficient literature analyzing macroscopic and microscopic methods of addressing emergency department (ED) operations, there is a paucity of studies that analyze methods between these extremes.


We conducted a quasi-experimental study incorporating a pre/post-intervention comparison to determine whether interdepartmental cooperation is effective at improving ED operations by combining microscopic and macroscopic concepts.


We performed an analysis of operational and financial data from a cooperative investment in imaging transport personnel between the emergency and radiology departments. Our primary outcome, order to table time (OTT), measured imaging times by modality (computed tomography [CT], ultrasound [US], magnetic resonance imaging [MRI]). These were compared for statistically significant change before and after the intervention. Our secondary outcome, gross profit, was calculated using the revenue generated from gained outpatient studies minus the associated direct personnel costs.


Transporters improved OTTs by decreasing median imaging times from 132 min to 116 min (p < 0.0005). Efficiency improved for CT scans with median time decreasing from 142 min to 114 min (p < 0.0005). Transport hires had adverse effects on US, with an increase in median OTT from 91 min to 99 min (p < 0.018). MRI experienced a similar trend in OTT, as median times worsened from 215 min to 235 min (p < 0.225). The investment in transporters generated a gross profit of $1.03 million for the radiology department over 9 months.


Interdepartmental cooperation is a broadly applicable macroscopic method that is effective at achieving microscopic, site-specific gains in ED efficiency. Transporters provided operational gains for the ED and financial gains for the radiology department.


imaging; management; operations; radiology

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