Table 4 Overview of outcomes of redesign interventions in included studies

1. Pennell, et al. (2005)

- Improved basal diabetes medications being ordered prior to discontinuing the IV insulin infusion (0 % → 76.9 %)

- Use of sliding scale insulin increased in undiagnosed patients (16 % → 21 %)

- Use of basal medications while on sliding scale insulin improved for diagnosed patients (56.3 % → 69 %)

- Increased number of documented blood glucose tests ordered for undiagnosed patients (2.8/day → 4.3/day)

- Improved diabetic patients’ blood glucose test values (88 % → 71 % range 140 to 299 mm/dL)

- The Average Length Of Stay (ALOS) for the overall population was reduced by 1.2 days

- The ALOS for diagnosed patients increased by 2.6 days

- The ALOS for undiagnosed patients decreased by 4.6 days

- The ALOS for diagnosed patients for the year was shorter than for undiagnosed patients

- Patients with a primary diagnosis of coronary artery bypass with cardiac cath with complications had a significantly longer ALOS at 12.9 days

- The ALOS of undiagnosed patients with coronary bypass with cardiac cath dropped after implementation

n/a

n/a

- Percentage of undiagnosed patients with postoperative infection dropped (16 % → 9.1 %)

- Percentage of diagnosed patients with a postoperative infection increased (0 % → 10 %)

- Diagnosed patients had fewer postoperative infections than undiagnosed patients (6.7 % vs. 12 %)

n/a

n/a

2. King, Ben-Tovim, Bassham (2006)

n/a

- Flattening of the review times

- Marked reduction in the variability of time spent waiting for review

- Time to initiation of meaningful treatment significantly decreased

- Time to see a doctor decreased

- A slight increase in overall compliance to meeting triage waiting times

- Percentage of all patients attending but not waiting to be seen after initial triaging fell significantly

- Decrease in patients presenting to the ED and waiting for more than 8 h before being admitted or discharged

- Significant decrease in mean time spent in the ED

- Significant decrease in time spent in the ED of patients being admitted

- Significant decrease in time spent in the ED of patients being discharged

- Decrease of overall time spent in the department

- - Decrease of time spent in the department before discharge

n/a

n/a

- No incidents of concerns associated with practice change

- Overall sense of a greater degree of patient safety, and sense of control among staff

n/a

n/a

3. Raab, Andrew-JaJA, Condel, et al. (2006)

- Significant decrease of Papanicolaou tests lacking a transformation zone component (9.9 % → 4.7 %)

- Reduced number of equivocal Papanicolaou test diagnoses (7.8 % → 3.9 %)

- Decreased costs

- Less additional testing (76 % → 29.4 %)

- Decreased laboratory

- time and effort in the screening of slides

n/a

n/a

- More women being diagnosed with appropriate categories

- - Decrease of error frequency per correlating cytologic-histologic specimen pair (9.52 % → 7.84 %)

n/a

n/a

4. Raab, et al. (2006)

- Improvement:

- Significantly higher diagnostic accuracy (70.2 % → 90.6 %).

- Decrease of Fine Needle Aspiration (FNA) (1543 → 1176 cases)

- Significant decrease in repeated FNA rate (12.7 % → 7.7 %)

- Significant decrease in non-interpretable rate for immediate interpretation service (23.8 % → 7.8 %)

- Deteriorations:

- Significant increase in non-interpretable rate (5.8 → 19.8 %) at terminology standardization

n/a

n/a

n/a

- Significantly fewer false-negative diagnoses (4.8 % → 19.1 %)

- Significantly fewer patients had surgery (23.6 % → 19.9 %)

- Deteriorations:

- - No significant increase in false-positive rate (22.6 → 26.3 %)

n/a

n/a

5. Shannon, et al. (2006)

- -Significant increase in line days (4,687 days → 7,716 days)

- Increase in admissions (11 %)

- Increased acuity

- Near doubling of line use without adding new staff or more beds

- - Reduced need to compensate for ineffective processes

n/a

n/a

- Reduced line infection rates after intervention (10.5/1000 → 0.39/1000 line days)

- - Significantly reduced line infection associated mortalities (51 % → 0 %)

n/a

- More time to be involved in direct patient care

- - More time for staff to solve problems

6. Kelly, Bryant, Cox, et al. (2007)

- Increased and sustained proportion of discharged patients (92 %)

- Improvements:

- Significant reduction of overall total ED department time (12 min)

- Significant reduction of total ED time for triage category 4 and 5 patients (14 and 18 min respectively)

- Deteriorations:

- Significant (*) increase in total ED time for category 1, 2 and 3 patients (9, 13 and 7* minutes respectively)

Significant reduction in

waiting time, overall and in triage categories 2–5 (3, 2, 5, 7 and 11 min respectively)

Increased bed

requests within target time (73 %)

n/a

- Episodes of ambulance bypass significantly decreased (120 → 54)

n/a

- - 90 % of staff reported that they believed the ED ran better after the change

7. Kim, et al. (2007)

n/a

- Reduction of process steps (16) to treatment

- Decrease of variability

Increase of percentage

of new patients with brain or bone metastases receiving consultation, simulation, and treatment on the same day (43 % → 94 %)

- Process time remained stable (225 min) while wait time decreased (1 week → 1 day)

n/a

- Fewer process errors in routing patient to appointment times

n/a

- n/a

8. Raab, Grzybicki, Condel, et al. (2007)

n/a

- Significantly increased productivity (3439 to 4047 work units/FTE)

- Decrease of expenditure

- Decreased specimen Turn Around Time (TAT) (9.7 h → 9.0 h)

n/a

n/a

n/a

n/a

n/a

9. Shendel-Falik, Feinson, Mohr (2007)

- Nutritional assessment improved by 11 %

- Completion of skin assessment in the ED improved by 70 %

- - Compliance with cardiac enzyme regimen improved by 9.2 %

- Percentage of telemetry patients able to be transported without a cardiac monitor increased by 60 %

- 67.5 h of nursing time per month were saved.

n/a

- Overall patient satisfaction improved on nursing issues (10.2 %)

- Satisfaction with personal issues improved (9 %)

- ED rating improved (23.3 %)

n/a

n/a

- - Improved nurse satisfaction and teamwork

10. Wood, Brennan, Chaudhry, et al. (2008)

n/a

- Shift from clinical notes dictated by physicians to clinical notes written by clinical assistants

- 21 % of the note was authored by clinical assistants and 79 % by physicians

n/a

n/a

- Significant improvements:

- Increased physician identification (from 57 % to 88 %)

- Increased allergy documentation (from 52 % to 70 %)

- Increased advance directives documentation (from 2 % to 83 %)

- Improved medication list completeness (from 32 % to 91 %)

n/a

- - Improved physician satisfaction

11. Reid, et al. (2009)

- PCMH patients had significantly better performance on

- each of the composite measures compared with 19 other clinics at baseline

- Significant improvement of composite quality of care at the PCMH compared to baseline (4 %) and control groups (1.4 %)

- Improvements

- PCMH patients received fewer in-person primary care visits (6 %)

- PCMH patients had significantly fewer ED visits (29 %)

- PCMH patients had significantly fewer hospitalizations for ambulatory care-sensitive conditions (11 %)

- PCMH patients had lower ED costs ($54 per patient per year)

- Deteriorations:

- PCMH patients had significantly more specialty care visits (8 %)

- PCMH patients had higher primary care costs per patient per year ($16 per patient per year)

- PCMH patients had higher specialty care costs ($37 per patient per year)

n/a

- PCMH patients reported significantly better experience with their care

- PCMH patients reported significantly higher scores on quality of doctor-patient interactions, coordination of care, patient activation/involvement and goal setting/tailoring

- Patients in the control groups reported significantly higher scores for patient activation/involvement and goal setting/tailoring.

- Patients at the PCMH clinic reported significantly higher scores on quality of doctor-patient interaction, shared decision making, coordination of care, access, patient activation/involvement and goal setting/tailoring

n/a

n/a

- Emotional exhaustion among physicians and physician assistants was reported significantly less frequently (20 %) at the PCMH clinic

12. Auerbach, et al. (2010)

- No significant differences in mortality rate

- No significant differences in readmission after 30 days

- Moderate decrease in adjusted hospital cost equivalent to a savings of $1439 per admission

n/a

- Statistically significant increases in the odds for a higher score in the co-management cohort for 3 questions: degree to which staff responded to concerns; cheerfulness of the hospital; and degree to which staff addressed patients’ emotional needs.

- - No significant differences in overall rating of the hospital experience and likelihood of recommending the hospital

n/a

n/a

- Non-nursing professionals support CNS; significantly improved attention to medical issues during hospitalization and at discharge

- - Nursing perceptions of the CNS’s effect on patient care were uniformly positive, with strongest positive change again being seen on questions regarding treatment of medical issues during hospitalization

12. Ravikumar, et al. (2010)

- - Significant improvement of readmission rates

- Significant reduction of total hospital patient days for patients being discharged from SICU to the regular beds or to PCU

- Net cost savings

- Decreased SICU Length Of Stay (LOS)

- Decreased PCU LOS:

- Decreased total hospital LOS SICU

- Decreased total hospital LOS PCU

- Cost savings: $851,511 to $2,007,388 per year.

- For DRG 148, reduction of variable cost was $452,000 per year

n/a

n/a

- Overall surgical mortality significantly decreased, with a corresponding improvement in mortality index for surgical DRGs

n/a

n/a

13. Hwang, Lee, Shin (2011)

n/a

- Improvement hospital layout remodeling:

- Significant (*) decrease of the mean time for the five processes: registration (7.78 %); CT/MRI enrollment (8.75 %); Complete Blood Count (CBC) sample collection (5.98 %); Prothrombin Time (PT)/Partial Thromboplastin Time (PTT) sample collection (19.73 %*); and CBC report (21.63 %*)

- Time reduction in PT/PTT sample collection process

- Significant reduction of total time from arrival to treatment (10.37 %)

- Significant decrease in length of stay (from 10.02 to 8.6 days)

- Significantly lower hospital charges (10.25 %)

- Deterioration hospital layout remodeling:

- Significant increase of CT/MRI and PT/PTT reporting process time (from 29.6 to 64.81 min; 28.99 %*)

- Improvement process redesign:

- Significant (*) decrease in process times: registration (22.76 %); CT/MRI enrollment (18.29 %); CBC sample collection (10.28 %); PT/PTT sample collection (14.32 %*); CT/MRI scan report (15.71 %*); PT/PTT report (3.59 %)

- Significant decrease in time from arrival to treatment (15.75 %)

- Significant decrease in LOS (from 12.98 to 9.25 days)

- Significantly lower hospital charges (16 %)

- Deterioration process redesign:

- - Increase in CBC report time (67.96 %)

n/a

n/a

n/a

n/a

n/a

14. Collar, et al. (2012)

n/a

- No significant difference in case length

- Mean Turn Over Time (TOT) was significantly shortened

- Turn Around Time (TAT) was significantly shortened

- Percentage of TOTs of 30 min increased

- Percentage of TATs of 60 min increased

- Approximately 4,500 min of added capacity yielded

- - Annual opportunity revenue for a single OR used twice weekly is approximately $330,000

n/a

n/a

n/a

n/a

- Significantly improved team morale

- - Operating Room Environment Measure did not change significantly

15. Krening, Rehling-Anthony, Garko (2012)

- Decrease in average length of labor on oxytocin for both primigravidas (10 h → 9.5 h) and multigravidas (8 h → 6.5 h).

- Significant decrease in hours receiving oxytocin for both primigravidas (9.9 h → 8.78 h) and multigravidas (7.8 h → 6.22 h)

- Decrease in primary cesarean rate (61 % → 56 %)

- A theoretical saving of at least $173,000 per year if volume remains constant, caused by reduced labor length

- A theoretical saving of approximately $286,000 per year, caused by reduced primary cesareans

n/a

n/a

- Significant decrease in overall incidence of tachysystole (54 % → 20 %)

n/a

n/a

16. Murray, Christen, Marsh, et al. (2012)

- Significant decrease in overall ‘return rates’ (162 → 97 patients)

- Discharge rate improved (22 % → 25 %)

- Significant decrease in proportion of patients requiring additional physical review by a consultant (89 → 22 patients)

- Significant improvement in utilization of the nurse-led fracture clinic (38 → 55 referrals)

n/a

n/a

- Significant increase in proportion of cases receiving primary consultant input (98 → 202 patients)

n/a

- Significant improvements in median scores of staff perception of education, provision of senior support, morale and overall perception of patient care.

- ER staff said the new style clinic was educational, practice-changing and improved interdisciplinary relations

- - Reduction of official incidence rates IR1 reports

17. Liss, et al. (2013)

- Significantly improved disease conditions for patients with diabetes; 4 % more likely to have A1C under 9.0 %, mean A1C 0.20 % lower

- Significant improved follow-up and disease conditions for patients with CHD; 11 % more likely to have LDL below 100 mg/dL at follow-up, mean LDL was 2.20 mg/dL lower

- Improved disease conditions for patients with hypertension; 5 % more likely to have blood pressure below 140/90 mmHg, not significant

- Significant decrease (23 %) in ambulatory care sensitive hospitalizations for patients at the PCMH

- Significant decrease (4 %) in inpatient admissions for patients at the PCMH

- Significant decrease (18 %) in ED and urgent care contacts

n/a

n/a

n/a

n/a

n/a