Purpose Two different systems for streaming patients were considered to improve efficiency measures such as waiting times (WTs) and length of stay (LOS) for a current emergency department (ED). A typical fast track area (FTA) and a fast track with a wait time threshold (FTW) were designed and compared effectiveness measures from the perspective of total opportunity cost of all patients' WTs in the ED. The paper aims to discuss these issues. Design/methodology/approach This retrospective case study used computerized ED patient arrival to discharge time logs (between July 1, 2009 and June 30, 2010) to build computer simulation models for the FTA and fast track with wait time threshold systems. Various wait time thresholds were applied to stream different acuity-level patients. National average wait time for each acuity level was considered as a threshold to stream patients. Findings The fast track with a wait time threshold (FTW) showed a statistically significant shorter total wait time than the current system or a typical FTA system. The patient streaming management would improve the service quality of the ED as well as patients' opportunity costs by reducing the total LOS in the ED. Research limitations/implications The results of this study were based on computer simulation models with some assumptions such as no transfer times between processes, an arrival distribution of patients, and no deviation of flow pattern. Practical implications When the streaming of patient flow can be managed based on the wait time before being seen by a physician, it is possible for patients to see a physician within a tolerable wait time, which would result in less crowded in the ED. Originality/value A new streaming scheme of patients' flow may improve the performance of fast track system.

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A process and flow control management scheme based on patient group characteristics may improve service quality and lead to a better patient satisfaction in ED.

Users of hand tools expect that tools after ergonomic changes in design will require less muscular activity and cause fewer musculoskeletal disorders than conventional tools. Reports on evaluation of ergonomic design changes in hand tools are controversial. In this study, we measured the effect of changes in tool design with physiological cost of performance and subjective ratings in a simulated setting. We determined physiological cost of performance by measuring muscle activity of the right and left forearm (flexor carpi ulnaris) with electromyography. We collected a questionnaire with subjective ratings before and after each experimental task. Before the tests, ergonomically reconfigured hacksaws received better rating scores than original hacksaws. However, we found no differences in subjective ratings of the hacksaws after the tests. In addition, electromyographic activity did not show any significant differences between the original and modified tools.

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