Improving emergency department efficiency by patient streaming to outcomes-based teams

Abstract

Objective: To describe the process and results of a process redesign based on task analysis and lean thinking approaches aimed at improving emergency department (ED) efficiency.Methods: Before-and-after study comparing 12-month periods before and after the process redesign for total episodes of ambulance bypass, waiting times (overall and by triage category) and total ED time (overall and by triage category). Time data were analysed using non-parametric methods. Results:The years were broadly comparable, with the exception that there was an 8.4% increase in total hours of care delivered (a marker of ED workload) in the year after the change. Episodes of ambulance bypass reduced by 55% (120 v 54). There were statistically significant waiting times reductions for triage categories 3 and 5 (median reductions 5 and 11 minutes respectively). There was an increase in total ED time for triage category 3 (median increase 7 min) and a decrease for categories 4 and 5 (median reduction 14 and 18 min, respectively). EMERGENCY DEPARTMENT (ED) OVERCROWDING is a growing problem in Australia and around the world. 1-3 Current understanding is that it is a complex interaction of hospital, ED, patient and ambulance factors. The results can be longer waiting times for patients, increased episodes of ambulance bypass, patients spending long periods "boarding" in the ED awaiting ward beds, and increased clinical risk. [4][5][6][7][8] Access block (shortage of available hospital beds to accommodate emergency patients requiring admission) seems to be the major contributor to ED overcrowding, 1,9,10 and a lot of work has been going into hospital systems to better manage beds. That said, there might be processes within EDs that also contribute to overcrowding. ConclusionThe aim of this project was to analyse ED patient flow processes using a task analysis and lean thinking approach, 11 and re-engineer these processes to improve flow through the ED for all groups of patients. MethodsThis project was undertaken in the ED of Western Hospital, a 300-bed, community teaching hospital in Melbourne, Australia. The ED treats adult patients only and has an annual census of about 32 000. It has two adjacent but separate treatment zones and 26 treatment spaces. It is staffed by a mixture of emergency physicians, registrars in training and other junior medical officers. Indicative admission rates by triage category for the study hospital are National Triage Scale (NTS) 1, 46%; NTS 2, 44%; NTS 3, 32%; NTS 4, 16% and NTS 5, 6%. The project had three main steps: patient flow and task a na lysis using lea n thinking approaches, 11 process redesign, and implementation and evaluation.

A case study of kanban implementation within the pharmaceutical supply chain

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“…Kelly et al 10 highlight that a 10-min reduction in total treatment time in the ED may not seem important to an individual patient. However, when achieved for 40 patients per day, it adds up to 400 min (i.e.…”

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“…Lummus et al (2006) and Kelly et al (2007) used Lean tools in a physician"s clinic and Emergency Department respectively to significantly improve patient flow and administrative processes. After two-and-a-half years of Lean implementation, the Flinders Medical Centre achieved a work increase of 15-20 per cent with fewer safety incidents on the same budget, using the same infrastructure, staff and technology (Gubb, 2009).…”