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Tackling the demand for emergency department services: there are no silver bullets
  1. Mathew Mercuri,
  2. Shawn E Mondoux
  1. Department of Medicine, Division of Emergency Medicine, McMaster University, Hamilton, Ontario, Canada
  1. Correspondence to Dr Mathew Mercuri, Department of Medicine, Division of Emergency Medicine, McMaster University, Hamilton, L8L 2X2 Ontario, Canada; mercurmd{at}

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A concern among ED service providers is that patient volumes and acuity are outpacing resources, prompting them to find ways to improve efficiency to meet service demands. In this issue of the Journal, Leung and colleagues1 introduce physician navigators as a novel strategy to increase emergency physician efficiency at a regional hospital in Ontario. The role of the navigator is to provide the ED physician with clerical support and assist in other organisational tasks, and their use led to an improvement in patient turnover at the study centre.

The results of this study are intuitive. A physician is limited in what he or she can do at any one time, and thus, some tasks must be completed serially. The availability of a navigator means that the physician can delegate non-clinical tasks so that he or she can effectively do two things at once. Thus, improved time-related outcomes are in keeping with the clinical process change instituted in this study. However, the physician is only part of the barrier to ED flow. Delays in registration and triage, or in other programmes such as radiology, laboratory and inpatient units may also …

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