After the completion of the data coding, the transcripts were reread, contrasted

to developed thematic categories and cross-referenced for relevance, consistency and relationships. A final test included a discussion of our findings with the department’s nursing team leader. Both design blueprints (before and after the refurbishment) are discussed to highlight changes necessary for an optimised interaction Inhibitors,research,lifescience,medical of time, space, information technology and people under this new model of emergency care. Results The 28 participants in this study (23 female and 5 male) included the system administrator, the change manager, 2 Emergency Department Assistants (EDAs), the operational services coordinator, 4 Emergency Nurse Practitioners (ENPs), 4 charge nurses (NICs) and 15 staff nurses. We analyse the way the introduction of the Inhibitors,research,lifescience,medical wait target reconfigured this ED, namely the spatial layout, the flow of patients through the department, the implementation of a new information technology and the flow of power through the clinical and professional relationships of its staff. By highlighting the “high interrelation” [57] of these social and technical aspects, we show how this Inhibitors,research,lifescience,medical new arrangement is stabilised, how it redefines and shapes emergency care as well as the unintended consequences of the new time constraint.

Redesigned Spaces: compartmentalisation The interviewees Inhibitors,research,lifescience,medical began by discussing how the physical space of

this ED was redesigned. This was because they had been treating an increasing number of ED attendees. There were also issues of security, privacy and dignity for their patients, particularly inside the treatment rooms. They came to the conclusion that the ED building plan and patterns of space usage were good enough for the old service model Inhibitors,research,lifescience,medical of treating patients in priority order but not the new “See and Treat” model of patient streaming. They also had to double the number of rooms and, therefore, their capacity to treat patients in dedicated spaces with dedicated staff. However, everything had to be done within the existing physical GSK1349572 concentration boundaries of the department. In order to optimise the safe and prompt flow of patients, the department had to be “compartmentalised”, meaning that the previous unitary network of ED clinicians had to be broken down into a Etomidate number of smaller networks of clinical teams and dedicated spaces. Moreover, the new layout had to facilitate better surveillance of all areas and easy way-finding for ED patients and visitors. By fine-tuning all these processes though integration or segregation, the department was thought to be better equipped to meet performance standards, while creating a satisfactory experience for patients and staff.