A Systematic Review on Lean Applications’ in Emergency Departments

Abstract

This article presents the state of the art of Lean principles applied in Emergency Departments through a systematic literature review. Our article extends previous work found in the literature to respond to the following questions: (i) What research problems in emergency departments can Lean principles help overcome? (ii) What Lean approaches and tools are used most often in this environment? (iii) What are the results and benefits obtained by these practices? and (iv) What research opportunities appear as gaps in the current state of the art on the subject? A six-step systematic review was performed following the guidance of the PRISMA method. The review analysis identified six main research problems where Lean was applied in Emergency Departments: (i) High Waiting Time and High Length of Hospital Stay; (ii) Health Safety; (iii) Process redesign; (iv) Management and Lessons Learned; (v) High Patient Flow; (vi) Cost Analysis. The six research problems’ main approaches identified were Lean Thinking, Multidisciplinary, Statistics, and Six Sigma. The leading Lean tools and methodologies were VSM, Teamwork, DMAIC, and Kaizen. The main benefits of applying Lean Principles were (a) reductions in waiting time, costs, length of hospital stay, patient flow, and procedure times; and (b) improvements in patient satisfaction, efficiency, productivity, standardization, relationships, safety, quality, and cost savings. Multidisciplinary integration of managers and work teams often yields good results. Finally, this study identifies knowledge gaps and new opportunities to study Lean best practices in healthcare organizations.

Lean-ing Method in an Emergency Department of the Italian Epicenter of the COVID-19 Outbreak: When the Algorithm Makes Difference

“…The proposed model had extremely positive impacts during the outbreak and stands out as one of the few studies on lean adoption in ED to face and re-organize patients' admissions during the COVID-19 outbreak. Additionally, this work contributes to promoting an algorithm in which lean is integrated using a multidisciplinary approach [2].…”

“…Innov. 2021, 4, 55 2 of 8 literature [1,2]. Particularly, lean helps to overcome various challenges such as waiting time, patient flow, bed unavailability, difficulty in screening, and length of hospital stay.…”

Exosomes Derived From Mesenchymal Stem Cells: Novel Effects in the Treatment of Ischemic Stroke

“…Adjuvant drugs such as anticoagulants, antiplatelet agents, and anti-inflammatory drugs may have a certain role in extending the therapeutic window ( Mahjoubin-Tehran et al, 2021 ). A new (“Lean Principles”) approach for optimizing the treatment process has also been reported, that allows patients with stroke to receive thrombolytic therapy within 60 min and improves their survival rate ( Souza et al, 2021 ). Nevertheless, this approach does not directly address the problem of vascular stenosis caused by thromboembolism or atherosclerotic plaque.…”

Modelling Granular Process Flow Information to Reduce Bottlenecks in the Emergency Department

“…Some of these have involved real-world interventions such as doctor-led triage, rapid assessment, fast tracking, streaming, alternative admission options during periods of access block, expansion of nursing scope of practice, the co-location of a primary care clinician in the ED, and Point-of-Care Testing (POCT), which have yielded varying degrees of success [34,56,58]. Other solutions broadly classified under lean, Six Sigma, and continuous quality improvement have also been applied to examine healthcare processes [17,35] including those related to ED bottlenecks [25,59]. For example, SIPOC (Supplier, Input, Process, Output, Customer), a Six Sigma methodology, has been used in processes within the obstetric unit [60].…”

“…Widely used in manufacturing, industrial engineering, and complex services [72][73][74], system modelling techniques are increasingly used in healthcare settings. Common among these are dataflow diagrams [75][76][77], flowcharting [76,78,79], Value Stream Mapping (VSM) [25,59,[80][81][82], and Role Activity Diagram (RAD) [75,[83][84][85]. Table 1 provides a comparison of the methods based on their ability to model attributes of the system, focussing on varying levels of granularity.…”