New directions in emergency service operations and planning.

Emergency services continue to evolve new operational and facility concepts in response to increasing demand for care and pressures for efficient, and safe, patient management. This article describes new models for "intake" of patients and for responding to peak demand that are radically changing the traditional emergency service. Application of Six Sigma and "Lean" analysis techniques are demonstrating dramatic improvements in throughput times and in the utilization of treatment spaces. This article provides an overview of the application of Lean concepts to emergency services. Case studies of Mary Washington Hospital and Banner Health Corporation illustrate the result of application of these tools. Implication for the required patient care areas and design concepts are also discussed.