Improving Emergency Department Efficiencies through Lean Process Implementation

2.50
Hdl Handle:
http://hdl.handle.net/10755/344159
Category:
Abstract
Type:
Poster
Title:
Improving Emergency Department Efficiencies through Lean Process Implementation
Author(s):
Bodine, Jennifer; Boland, Roy
Lead Author STTI Affiliation:
Non-member
Author Details:
Jennifer Bodine, MHA, MSN, RN, CEN, jennifer.bodine@tenethealth.com; Roy Boland, MHA, MSN, RN
Abstract:
Evidence-based Practice Abstract Purpose: The national benchmark for patients Leaving Without Being Seen (LWBS) is 1% and Leaving Without Treatment (LWOT) is 2%. Emergency Departments (ED) who successfully reduce their LWBS and LWOT rates simultaneously experience a reduction of harmful patient outcomes due to non-treatment and an increase in customer satisfaction ratings. In the fourth quarter of 2012, the ED designed an LWOT and LWBS rate reduction project with a focus on internal process improvements through lasting culture change. Lean-management strategies were applied to find unrealized efficiencies within the triage and diagnostic phases of patient care. Design: This was a Quality Assurance project. Setting: A 44-bed emergency department in an urban hospital with an average annual volume of 45,000. Participants/Subjects: The participants in this project were physicians, physician assistants, nurse practitioners, registered nurses, and ED technicians. Methods: Data was collected reflecting historical trends from 2010-2012. The current processes were value-stream mapped identifying opportunities for reducing systemic inefficiencies. A focus group was formed with staff level involvement to determine effective Lean process implementation strategies. Kiazen events were employed to make targeted process improvements focusing on quick “fixes” with mandatory compliance. Interventions centered on the triage process to include initiation of lab draws, X-rays, and CT scans while the patient was still in the waiting room were employed. Additionally, protocols were amended to allow patients to be quickly transferred from the waiting room to an empty bed with the primary nurse assuming the responsibility of triaging the patient (pull-to-full). Education was provided regarding the new triage protocols and the pull-to-full process. Throughout implementation, staff members were kept informed of process modifications during monthly staff meetings, daily safety huddles, and individual interactions. At the implementation level, shift charge nurses were held accountable for maintaining process compliance. At the supervisory level, management closely coordinated with the charge nurses and the staff by providing feedback regarding an individual’s effectiveness within the new process. At monthly staff meetings, management supplied departmental metrics on turn-around-times, LWOTs, and LWBSs to highlight positive trends that resulted from both the individuals’ and the ED’s collective efforts. Furthermore, the ED medical director shared daily and monthly statistics with physicians and mid-level providers regarding individual turn-around-times. Based on the data provided to these groups, the ED medical director set future expectations for performance improvements. Results/Outcomes: Over an 11 month period, the ED realized a 69% reduction in the combined LWBS/LWOT percentage, dropping from an average 4% rate in February 2012 to an average 1.25% rate in December 2013. Implications: In 2013, the process improvements resulted in 200 fewer LWBS patients and 893 less LWOT patients than the same time period in 2012. Furthermore, a 6.61% growth in total volume was achieved, during the same time, independent of recapturing the LWOT and LWBS volume. With implementation of additional Lean processes, further improvements are expected in turn-around-times and customer satisfaction.
Keywords:
Improving ED Efficiency
Repository Posting Date:
4-Feb-2015
Date of Publication:
4-Feb-2015
Conference Date:
2014
Conference Name:
2014 ENA Annual Conference
Conference Host:
Emergency Nurses Association
Conference Location:
Indianapolis, Indiana, U.S.A.
Description:
2014 ENA Annual Conference Theme: Safe Practice, Safe Care. Held at the Indiana Convention Center
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.language.isoen_USen_GB
dc.type.categoryAbstracten_GB
dc.typePosteren_GB
dc.titleImproving Emergency Department Efficiencies through Lean Process Implementationen_GB
dc.contributor.authorBodine, Jenniferen_GB
dc.contributor.authorBoland, Royen_GB
dc.contributor.departmentNon-memberen_GB
dc.author.detailsJennifer Bodine, MHA, MSN, RN, CEN, jennifer.bodine@tenethealth.com; Roy Boland, MHA, MSN, RNen_GB
dc.identifier.urihttp://hdl.handle.net/10755/344159-
dc.description.abstractEvidence-based Practice Abstract Purpose: The national benchmark for patients Leaving Without Being Seen (LWBS) is 1% and Leaving Without Treatment (LWOT) is 2%. Emergency Departments (ED) who successfully reduce their LWBS and LWOT rates simultaneously experience a reduction of harmful patient outcomes due to non-treatment and an increase in customer satisfaction ratings. In the fourth quarter of 2012, the ED designed an LWOT and LWBS rate reduction project with a focus on internal process improvements through lasting culture change. Lean-management strategies were applied to find unrealized efficiencies within the triage and diagnostic phases of patient care. Design: This was a Quality Assurance project. Setting: A 44-bed emergency department in an urban hospital with an average annual volume of 45,000. Participants/Subjects: The participants in this project were physicians, physician assistants, nurse practitioners, registered nurses, and ED technicians. Methods: Data was collected reflecting historical trends from 2010-2012. The current processes were value-stream mapped identifying opportunities for reducing systemic inefficiencies. A focus group was formed with staff level involvement to determine effective Lean process implementation strategies. Kiazen events were employed to make targeted process improvements focusing on quick “fixes” with mandatory compliance. Interventions centered on the triage process to include initiation of lab draws, X-rays, and CT scans while the patient was still in the waiting room were employed. Additionally, protocols were amended to allow patients to be quickly transferred from the waiting room to an empty bed with the primary nurse assuming the responsibility of triaging the patient (pull-to-full). Education was provided regarding the new triage protocols and the pull-to-full process. Throughout implementation, staff members were kept informed of process modifications during monthly staff meetings, daily safety huddles, and individual interactions. At the implementation level, shift charge nurses were held accountable for maintaining process compliance. At the supervisory level, management closely coordinated with the charge nurses and the staff by providing feedback regarding an individual’s effectiveness within the new process. At monthly staff meetings, management supplied departmental metrics on turn-around-times, LWOTs, and LWBSs to highlight positive trends that resulted from both the individuals’ and the ED’s collective efforts. Furthermore, the ED medical director shared daily and monthly statistics with physicians and mid-level providers regarding individual turn-around-times. Based on the data provided to these groups, the ED medical director set future expectations for performance improvements. Results/Outcomes: Over an 11 month period, the ED realized a 69% reduction in the combined LWBS/LWOT percentage, dropping from an average 4% rate in February 2012 to an average 1.25% rate in December 2013. Implications: In 2013, the process improvements resulted in 200 fewer LWBS patients and 893 less LWOT patients than the same time period in 2012. Furthermore, a 6.61% growth in total volume was achieved, during the same time, independent of recapturing the LWOT and LWBS volume. With implementation of additional Lean processes, further improvements are expected in turn-around-times and customer satisfaction.en_GB
dc.subjectImproving ED Efficiencyen_GB
dc.date.available2015-02-04T11:27:33Z-
dc.date.issued2015-02-04-
dc.date.accessioned2015-02-04T11:27:33Z-
dc.conference.date2014en_GB
dc.conference.name2014 ENA Annual Conferenceen_GB
dc.conference.hostEmergency Nurses Associationen_GB
dc.conference.locationIndianapolis, Indiana, U.S.A.en_GB
dc.description2014 ENA Annual Conference Theme: Safe Practice, Safe Care. Held at the Indiana Convention Centeren_GB
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.en_GB
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