Lean techniques for the improvement of patients' flow in emergency department

doi:10.5847/wjem.j.issn.1920-8642.2014.01.004

Abstract

Abstract:

BACKGROUND: Emergency departments (EDs) face problems with overcrowding, access block, cost containment, and increasing demand from patients. In order to resolve these problems, there is rising interest to an approach called "lean" management. This study aims to (1) evaluate the current patient flow in ED, (2) to identify and eliminate the non-valued added process, and (3) to modify the existing process.
METHODS: It was a quantitative, pre- and post-lean design study with a series of lean management work implemented to improve the admission and blood result waiting time. These included structured re-design process, priority admission triage (PAT) program, enhanced communication with medical department, and use of new high sensitivity troponin-T (hsTnT) blood test. Triage waiting time, consultation waiting time, blood result time, admission waiting time, total processing time and ED length of stay were compared.
RESULTS: Among all the processes carried out in ED, the most time consuming processes were to wait for an admission bed (38.24 minutes; SD 66.35) and blood testing result (mean 52.73 minutes, SD 24.03). The triage waiting time and end waiting time for consultation were significantly decreased. The admission waiting time of emergency medical ward (EMW) was significantly decreased from 54.76 minutes to 24.45 minutes after implementation of PAT program (P<0.05).
CONCLUSION: The application of lean management can improve the patient flow in ED. Acquiesce-nce to the principle of lean is crucial to enhance high quality emergency care and patient satisfaction.

Key words: Lean, Triage, Waiting time, Patient flow, Emergency department

HY Chan, SM Lo, LLY Lee, WYL Lo, WC Yu, YF Wu, ST Ho, RSD Yeung, JTS Chan. Lean techniques for the improvement of patients' flow in emergency department[J]. World Journal of Emergency Medicine, 2014, 5(1): 24-28.

Figures/Tables 5

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References 13

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Process change	Specific example	Expected outcome
Structured re-design process	Re-engineering the layout of each consultation room	Reduce end waiting consultation time
	Inventory control and easy access in each consultation room	Reduce total processing time
	Relocate the drug cupboard	Reduce triage waiting time
	Relocate the treatment area	Reduce intervention time
	Increase the number of consultation rooms
	Re-design the signage
	Re-construct nursing station
Priority Admission Triage Program	Admission screening and prioritization by emergency specialist	Reduce EMW admission waiting time
Priority Admission Triage Program	Diverse the sub-acute medical patient to EMW	Reduce avoidable medical admission
Communication with medical department	Centralized bed co-ordination system	Reduce admission waiting time
	Report medical bed vacancy every three hours
	Update medical bed vacancy in a timely manner	Reduce ED overcrowding
	Consult medical bed coordinator in urgent situation
	Activate overflow system when necessary
Cardiac Troponin-T blood test	Perform for patient complained of chest pain	Reduce blood result time
	Distinguish unstable angina patient from one with myocardial infarction without ST-segment elevation
	High sensitivity and specificity	Reduce total processing time

Variables	Pre-lean mean (min)	Post-lean mean (min)	P<
Triage waiting time	3.18 (4.235)	2.63 (3.591)	0.05
Consultation waiting time	13.68 (9.731)	11.65 (7.213)	0.05
Final waiting time	16.86 (10.92)	14.28 (7.876)	0.05
Blood result time	60.01 (30.31)	76.42 (33.69)	NS
Admission waiting time	28.99 (55.60)	38.24 (66.34)	0.05
EMW admission waiting time	54.76 (80.89)	24.45 (41.63)	0.05
Processing time	100.86 (81.40)	143.41 (114.26)	0.05
Length of stay in ED	117.71 (82.28)	157.70 (113.51)	0.05

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