Emergency department structure and operations

Introduction: Recent position statements from health care organizations have placed a strong emphasis on continuous quality improvement (CQI). CQI finds many of its roots in kaizen, which emphasizes small, low-cost, low-risk improvements. Based on the successful Kaizen Programs at organizations such as Toyota, the authors thought the emergency department (ED) would be an ideal environment to benefit from such a program.

Section: Discussionmentioning

confidence: 99%

Kaizen: A Method of Process Improvement in the Emergency Department

Jacobson

McCoin

Lescallette

et al. 2009

“…Emergency medicine microsystems have been referenced previously 14 due to their significance. By envisioning large‐scale systems (macrosystems) as constructed of smaller systems (microsystems) that produce quality, safety, and cost outcomes at the frontline of care, 13,15,16 it can be inferred that “the outcomes of the macrosystems can be no better than the microsystems of which it is composed.” 13 This insight allows linkage of EM systems and microsystems to organizational performance metrics such as the Patient Value Compass.…”

Section: Application Of Quality Management and Human Factors Principlmentioning

confidence: 99%

Advanced Medical Simulation Applications for Emergency Medicine Microsystems Evaluation and Training

Kobayashi

Overly

Fairbanks

et al. 2008

Participants in the 2008 Academic Emergency Medicine Consensus Conference ''The Science of Simulation in Healthcare: Defining and Developing Clinical Expertise'' morning workshop session on developing systems expertise were tasked with evaluating best applications of simulation techniques and technologies to small-scale systems in emergency medicine (EM). We collaborated to achieve several objectives: 1) describe relevant theories and terminology for discussion of health care systems and medical simulation, 2) review prior and ongoing efforts employing systems thinking and simulation programs in general medical sectors and acute care medicine, 3) develop a framework for discussion of systems thinking for EM, and 4) explore the rational application of advanced medical simulation methods to a defined framework of EM microsystems (EMMs) to promote a ''quality-by-design'' approach. This article details the materials compiled and questions raised during the consensus process, and the resulting simulation application framework, with proposed solutions as well as their limitations for EM systems education and improvement. ACADEMIC EMERGENCY MEDICINE 2008; 15:1058-1070 ª 2008 by the Society for Academic Emergency MedicineKeywords: emergency medicine, health services research, health care evaluation mechanisms, simulation, systems analysis, systems theory A ctivities of large organizations can be viewed and studied as the product of highly connected, dynamic, and interdependent groups exhibiting emergent properties, i.e., systems. Application of this framework as a problem-solving approach to contextualize institutions; explore the hierarchies and interactions

“…Emergency department operations management and research methods are gaining acceptance in U.S. academic institutions as a means of applying manufacturing concepts to the health care system to decrease variation in health care delivery, improve the quality of patient care, and decrease overall health care costs 4–6 . Understanding and optimizing measures such as patient arrival patterns, occupancy level, length of stay, and time until seen by a nurse or physician aid in improving clinical operations and patient satisfaction.…”

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confidence: 99%

“…Private industry has led the way in using operations management tools such as Lean management, six sigma, queuing theory, statistical process control, and mathematical simulation modeling to improve industrial operations. Recently, these tools have been applied to improve the dynamic setting of EM and have demonstrated success in improving ED patient care metrics 4,7–13 …”

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confidence: 99%

Optimizing Clinical Operations as Part of a Global Emergency Medicine Initiative in Kumasi, Ghana: Application of Lean Manufacturing Principals to Low‐resource Health Systems

Carter

Desmond

Akanbobnaab

et al. 2012

Background Although many global health programs focus on providing clinical care or medical education, improving clinical operations can have a significant effect on patient care delivery, especially in developing health systems without high-level operations management. Lean manufacturing techniques have been effective in decreasing emergency department (ED) length of stay, patient waiting times, numbers of patients leaving without being seen, and door-to-balloon times for ST-elevation myocardial infarction in developed health systems; but use of Lean in low to middle income countries with developing emergency medicine systems has not been well characterized. Objectives To describe the application of Lean manufacturing techniques to improve clinical operations at Komfo Anokye Teaching Hospital in Ghana and to identify key lessons learned to aid future global EM initiatives. Methods A three-week Lean improvement program focused on the hospital admissions process at Komfo Anokye Teaching Hospital was completed by a 14-person team in six stages: problem definition, scope of project planning, value stream mapping, root cause analysis, future state planning, and implementation planning. Results The authors identified eight lessons learned during our use of Lean to optimize the operations of an ED in a global health setting: 1) the Lean process aided in building a partnership with Ghanaian colleagues; 2) obtaining and maintaining senior institutional support is necessary and challenging; 3) addressing power differences among the team to obtain feedback from all team members is critical to successful Lean analysis; 4) choosing a manageable initial project is critical to influence long-term Lean use in a new environment; 5) data intensive Lean tools can be adapted and are effective in a less resourced health system; 6) several Lean tools focused on team problem solving techniques worked well in a low resource system without modification; 7) using Lean highlighted that important changes do not require an influx of resources; 8) despite different levels of resources, root causes of system inefficiencies are often similar across health care systems, but require unique solutions appropriate to the clinical setting. Conclusions Lean manufacturing techniques can be successfully adapted for use in developing health systems. Lessons learned from this Lean project will aid future introduction of advanced operations management techniques in low to middle income countries.