Improving door-to-doctor and door-to-analgesia time in a tertiary teaching hospital emergency department through a novel ‘Red Box’ system

Objectives: To evaluate the effectiveness of a new patient flow system, ‘The Red Box’ on the quality of patient care in respect of the time taken for the care to be delivered to the patient. Methods: A pre-post study was conducted looking at the door-to-doctor (DTD) and door-to-analgesia  (DTA) times for cases presenting to the Emergency Department (ED) of a tertiary teaching hospital, The National University of Malaysia Medical Center, Kuala Lumpur, Malaysia, between the periods of July and September 2005 against July and September 2008. Demographic data, ED presentation time, time seen by first doctor, and time first analgesia given were collected in both periods and analyzed. Results: A total of 1,000 cases were enrolled. Group A (pre-Red Box) and group B (post-Red Box) comprised 500 cases each. The mean DTD time for group A was 29 minutes (SD ± 3 minutes) and for group B was 3 minutes (SD ± 1 minute), with a 98.8% reduction ( p <0.001). For DTA time, group A recorded a mean of 46 minutes (SD ± 3 minutes), and group B recorded a mean of 9 minutes (SD ± 2 minutes), an 80.4% reduction ( p <0.001). Conclusion: The implementation of a red box system improved the quality of emergency patient care in the ED of a tertiary teaching hospital as evidenced by significant reductions in DTD and DTA time.