The causes of the problem are two fold. The first is that the inflow of patients into the ED is not evenly spaced throughout the day and occurs as a rush during fours in the late evening and night. No plan can be created for changing the pattern of inflow of patients into the ED, as they occur as naturally. The second is that during the peak flow of patients into the ED, the services that are required to provide support for the ED in the provision of timely and quality care are functioning at their minimal ability, since they are in the after-hours mode. This is the cause that the sigma team to address in overcoming the problem.
Practical barriers to receiving quality care in an ED is dependent on two key factors of access to service at the ED and the availability of the services required support services either in the ED or immediately accessible (Rust et al, 2008). Overcoming these barriers to quality service calls for consideration of the types of patients and the emergencies and the resources at the ED (Frush, 2007). The essential problem in quality care in an ED is the mismatch in the demand and supply of resources at the ED. From the perspective of the patient seamless provision of care from the time of arrival at the ED is the quality of service expected. The first step is this direction is preventing diversion of ambulances to the ED, which will reduce the overcrowding at the ED (Stokowski, 2007).
The next step consists in organizing the ED into three separate areas to attend to areas to attend to medical problems, surgical problems and Urgent care area for triaging of patients. Staffing of the ED is the next issue. Since the ED peaks between 6.00 pm and 10.00 pm specialist services in the required different branches of medicine will be available. In addition the number of interns or residents at the ED will peak during this period of