Hospital - Emergency Department Receiving and Admission
Implemented a number of changes to improve flow in the emergency room to reduce patient wait time and overall stay from arrival to discharge. They have reduced patient wait times by 25% to 40%.
Reducing Waiting and Frustration for both the Patient and Staff
Lean Healthcare Inc. has worked with Emergency Departments (ED) at hospitals. And like all emergency departments, the staff in the Emergency Department work under enormous stress and the workload has continued to increase impacting wait times. This type of environment creates an atmosphere of frustration and anxiety.
In this particular case, the Emergency Department team was introduced to Lean. Not surprisingly, the team thought that they were unique and that there was just too much
variation in their work to apply any methods or concepts that would help them.
Lean Healthcare Inc. convinced them to complete a Current Value Stream map. The map included all processing steps from the moment the patient presents themselves to Emergency Department, to when they were either treated and discharged or admitted to the Hospital.
A Future State Map was then created focused on improving flow and handoffs between several critical processing steps. The team was surprised that within their unique environment that there was a number of opportunities within their control creating variation beyond what would be considered or expected by natural variation.
A significant problem within their Value Stream was the variation and lack of standardization in terms of how different team members conducted their assessment, testing, care and treatment. A major kaizen was planned and organized with the goal to develop standard practices to reduce patient time in Emergency Department (reduce the waste of waiting) and providing optimum care (improve quality and service).
Other issues identified, were with the delays experienced by Emergency Department in terms of waiting for the Hospital Admissions physician to show up in Emergency Department before a bed could be requested and the time it took to get a bed assigned.
The impact of this waiting was:
- An increase in unnecessary wait time for the patient in Emergency Department
- Unnecessary stress and patient dissatisfaction
- Unnecessary stress and frustration of the staff
- The rooms in Emergency Department were filled by patients waiting to be moved
- The arriving patients had to wait longer for an Emergency Department room
- The Emergency Department nurse was spending much more time providing 'hospital floor nursing care' rather than Emergency Department 'nursing care'.
The result is the team that thought they were unique, and that the status quo was the way it had to be, are now motivated to implement changes in their information flows and communication flows in order to improve the entire end-to-end system. The team has just started to implement a number of the planned changes to improve flow in the emergency room, and reduce patient wait time, and overall stay from arrival to discharge. Once they complete the Future State in three months, they will have reduced the wait times by 25% to 40%.