Aim To examine the role of workflow redesign to improve medication reconciliation at four Washington State community hospital emergency departments.

Method Lean redesign methodology was used for workflow process mapping and redesign workshops attended by emergency department staff. Observations were made about barriers to successful operation of current medication reconciliation workflows, and ideal future process maps were developed to improve the efficacy of creating a current, complete and accurate medication list for each patient seen in the emergency department.

Conclusion Ideas for an optimal workflow to generate a medication list include involving patients and utilising clerical staff to a greater extent in medication information gathering, identifying and flagging patients with missing medication information, and gathering only the medication information needed to make clinical decisions in the emergency department.