2.50
Hdl Handle:
http://hdl.handle.net/10755/198349
Title:
Going Lean: Improving Emergency Department Flow
Abstract:
[ENA Annual Conference 2011 - Evidence-based Practice Presentation] Going Lean: Improving emergency department flow

Purpose: A busy suburban emergency department (ED) had experienced growing patient wait times for admission beds causing increased wait times in the lobby. Patient and staff satisfaction scores were below national benchmark.

Design: Lean methodology has been integrated into health care systems to focus on customer value while minimizing waste. A multidisciplinary team received training and completed value stream analysis. The team was charged with determining areas of impact to optimize flow in the organization. The focus was on decreasing ED wait times to improve patient care. This quality improvement project utilized evidence based practice models to improve five critical areas requiring improvement.

Setting: A 54 bed, suburban emergency department (ED) in the Midwestern United States.

Participants: Team members from the ED, intensive care unit, medical unit, telemetry unit, laboratory, radiology, environmental services, patient placement, registration and quality improvement were asked to commit to time intensive work changing processes in the organization.

Methods: Five areas of change were identified utilizing value stream analysis. Change areas included; organization, communication, laboratory, admission and triage processes. Rapid cycle improvement (RCI) theory was utilized for each improvement and included an aim statement that was focused on the patient’s perspective of care. Measurable goals were determined and articulated to the staff by team members for each RCI. Senior leadership was involved to ensure that resource acquisition and team support was available. Educational offerings and goal expectations were developed and explained by team members for each RCI.

Results/Outcomes: The organization RCI required utilization of five S Lean methodology. Team members sorted through each area of the ED, setting items in order, shining and standardizing through acquisition of new standard carts. Each area was re-confiqured and foot- printed to improve consistency and eliminate waste. Communication improvements included closed intercom walkie talkies for staff use, use of white boards for patient communication and scripting guidelines for staff. Lab improvements included expanding the role of the point of care lab technician in the ED. The admission RCI required collaboration between all areas of the hospital. The hospitalist and ED physicians developed an in-patient admission order set to enhance patient admission. Software updates were implemented to improve communication between ED staff members. Target developed of 60 minutes from admission order to discharge from ED. Average time to admission has decreased from 6.9 hours to 4.9 hours. The triage RCI required process changes. Criteria for express care were refined to ensure appropriate patient placement. Rapid medical exam at triage was streamlined to avoid batching of patients. A core team of triage and express nurses were identifed, resulting in improved consistency and efficiency. Express care length of stay is consistently less than 90 minutes. Patient satisfaction improved from 53% to 71%.

Implications: Lean methodology can be successful in the ED setting. A sustainability plan is essential to maintain early successes. Clear communication regarding goals and roles and responsibilities must be maintained. Anticipating conflict and managing it constructively is essential.
Repository Posting Date:
21-Dec-2011
Date of Publication:
21-Dec-2011

Full metadata record

DC FieldValue Language
dc.titleGoing Lean: Improving Emergency Department Flowen_GB
dc.identifier.urihttp://hdl.handle.net/10755/198349-
dc.description.abstract[ENA Annual Conference 2011 - Evidence-based Practice Presentation] Going Lean: Improving emergency department flow<br/><br/>Purpose: A busy suburban emergency department (ED) had experienced growing patient wait times for admission beds causing increased wait times in the lobby. Patient and staff satisfaction scores were below national benchmark. <br/> <br/>Design: Lean methodology has been integrated into health care systems to focus on customer value while minimizing waste. A multidisciplinary team received training and completed value stream analysis. The team was charged with determining areas of impact to optimize flow in the organization. The focus was on decreasing ED wait times to improve patient care. This quality improvement project utilized evidence based practice models to improve five critical areas requiring improvement. <br/> <br/>Setting: A 54 bed, suburban emergency department (ED) in the Midwestern United States. <br/><br/>Participants: Team members from the ED, intensive care unit, medical unit, telemetry unit, laboratory, radiology, environmental services, patient placement, registration and quality improvement were asked to commit to time intensive work changing processes in the organization.<br/><br/>Methods: Five areas of change were identified utilizing value stream analysis. Change areas included; organization, communication, laboratory, admission and triage processes. Rapid cycle improvement (RCI) theory was utilized for each improvement and included an aim statement that was focused on the patient’s perspective of care. Measurable goals were determined and articulated to the staff by team members for each RCI. Senior leadership was involved to ensure that resource acquisition and team support was available. Educational offerings and goal expectations were developed and explained by team members for each RCI. <br/><br/>Results/Outcomes: The organization RCI required utilization of five S Lean methodology. Team members sorted through each area of the ED, setting items in order, shining and standardizing through acquisition of new standard carts. Each area was re-confiqured and foot- printed to improve consistency and eliminate waste. Communication improvements included closed intercom walkie talkies for staff use, use of white boards for patient communication and scripting guidelines for staff. Lab improvements included expanding the role of the point of care lab technician in the ED. The admission RCI required collaboration between all areas of the hospital. The hospitalist and ED physicians developed an in-patient admission order set to enhance patient admission. Software updates were implemented to improve communication between ED staff members. Target developed of 60 minutes from admission order to discharge from ED. Average time to admission has decreased from 6.9 hours to 4.9 hours. The triage RCI required process changes. Criteria for express care were refined to ensure appropriate patient placement. Rapid medical exam at triage was streamlined to avoid batching of patients. A core team of triage and express nurses were identifed, resulting in improved consistency and efficiency. Express care length of stay is consistently less than 90 minutes. Patient satisfaction improved from 53% to 71%.<br/><br/>Implications: Lean methodology can be successful in the ED setting. A sustainability plan is essential to maintain early successes. Clear communication regarding goals and roles and responsibilities must be maintained. Anticipating conflict and managing it constructively is essential. <br/>en_GB
dc.date.available2011-12-21T12:46:50Z-
dc.date.issued2011-12-21T12:46:50Z-
dc.date.accessioned2011-12-21T12:46:50Z-
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