Using Lean Management to Reduce Emergency Department Length of Stay for Medicine Admissions

Allaudeen, Nazima; Vashi, Anita; Breckenridge, Julia S.; Haji‐Sheikhi, Farnoosh; Wagner, Sarah; Posley, Keith A; Asch, Steven M.

doi:10.1097/qmh.0000000000000132

Cited by 26 publications

(27 citation statements)

References 16 publications

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“…In recent years many studies have evaluated Lean initiatives,51–53 fast-track areas in the ED,54–6, physicians in triage,57 and full capacity protocols,58 although the vast majority of these studies took place in urban centers. Furthermore, most studies examine just one initiative while our study included a large initiative with seven parts.…”

Section: Discussionmentioning

confidence: 99%

SurgeCon: Priming a Community Emergency Department for Patient Flow Management

Patey

Norman²,

Araee

et al. 2019

WestJEM

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Introduction Canadian emergency departments (ED) are struggling to provide timely emergency care. Very few studies have assessed attempts to improve ED patient flow in the rural context. We assessed the impact of SurgeCon, an ED patient-management protocol, on total patient visits, patients who left without being seen (LWBS), length of stay for departed patients (LOSDep), and physician initial assessment time (PIA) in a rural community hospital ED. Methods We implemented a set of commonly used methods for increasing ED efficiency with an innovative approach over 45 months. Our intervention involved seven parts comprised of an external review, Lean training, fast track implementation, patient-centeredness approach, door-to-doctor approach, performance reporting, and an action-based surge capacity protocol. We measured key performance indicators including total patient visits (count), PIA (minutes), LWBS (percentage), and LOSDep (minutes) before and after the SurgeCon intervention. We also performed an interrupted time series (ITS) analysis. Results During the study period, 80,709 people visited the ED. PIA decreased from 104.3 (±9.9) minutes to 42.2 (±8.1) minutes, LOSDep decreased from 199.4 (±16.8) minutes to 134.4(±14.5) minutes, and LWBS decreased from 12.1% (±2.2) to 4.6% (±1.7) despite a 25.7% increase in patient volume between pre-intervention and post-intervention stages. The ITS analysis revealed a significant level change in PIA – 19.8 minutes (p<0.01), and LWBS – 3.8% (0.02), respectively. The change over time decreased by 2.7 minutes/month (p< 0.001), 3.0 minutes/month (p<0.001) and 0.4%/month (p<0.001) for PIA, LOSDep, and LWBS, after the intervention. Conclusion SurgeCon improved the key wait-time metrics in a rural ED in a country where average wait times continue to rise. The SurgeCon platform has the potential to improve ED efficiency in community hospitals with limited resources.

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Section: Discussionmentioning

confidence: 99%

SurgeCon: Priming a Community Emergency Department for Patient Flow Management

Patey

Norman²,

Araee

et al. 2019

WestJEM

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“…In addition, standardization is a tenant of the 5S model (sort, set in order, shine, standardize, and sustain) for quality improvement, and has resulted in improvement in efficiency in other projects in healthcare. 28,29 However, further assessment of impact on provider experience is needed before consideration of a wider application.…”

Section: Discussionmentioning

confidence: 99%

Interventions to reduce emergency department consultation time: A systematic review of the literature

Beckerleg

Wooller

Hasimjia

2019

CJEM

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ObjectivesOvercrowding in the emergency department (ED) is associated with increased morbidity and mortality. Studies have shown that consultation to decision time, defined as the time when a consultation has been accepted by a specialty service to the time when disposition decision is made, is one important contributor to the overall length of stay in the ED.The primary objective of this review is to evaluate the impact of workflow interventions on consultation to decision time and ED length of stay in patients referred to consultant services in teaching centres, and to identify barriers to reducing consultation to decision time.MethodsThis systematic review was performed in accordance with the PRISMA guidelines. An electronic search was conducted to identify relevant studies from MEDLINE, EMBASE, Cochrane Central, and CINAHL databases. Study screening, data extraction, and quality assessment were carried out by two independent reviewers.ResultsA total of nine full text articles were included in the review. All studies reported a decrease in consultation to decision time post intervention, and two studies reported cost savings. Interventions studied included short messaging service (SMS) messaging, education with audit and feedback, standardization of the admission process, implementation of institutional guideline, modification of the consultation process, and staffing schedules. Overall study quality was fair to poor.ConclusionsThe limited evidence suggests that audit and feedback in the form of SMS messaging, direct consultation to senior physicians, and standardization of the admission process may be the most effective and feasible interventions. Additional high-quality studies are required to explore sustainable interventions aimed at reducing consultation to decision time.

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“…One of the most popular approaches in this domain is lean manufacturing (LM, 20 papers = 27.77%). In this regard, Allaudeen et al [48] performed a multidisciplinary lean intervention where root causes of delays were properly identified and tackled. In fact, the ED LOS for medicine admissions decreased by 26.4% from 8.7 to 6.4 h (p-value < 0.01).…”

Section: Papers Focusing On Reducing the Extended Losmentioning

confidence: 99%

Methodological Approaches to Support Process Improvement in Emergency Departments: A Systematic Review

Ortíz‐Barrios

Alfaro-Saiz

2020

IJERPH

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The most commonly used techniques for addressing each Emergency Department (ED) problem (overcrowding, prolonged waiting time, extended length of stay, excessive patient flow time, and high left-without-being-seen (LWBS) rates) were specified to provide healthcare managers and researchers with a useful framework for effectively solving these operational deficiencies. Finally, we identified the existing research tendencies and highlighted opportunities for future work. We implemented the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology to undertake a review including scholarly articles published between April 1993 and October 2019. The selected papers were categorized considering the leading ED problems and publication year. Two hundred and three (203) papers distributed in 120 journals were found to meet the inclusion criteria. Furthermore, computer simulation and lean manufacturing were concluded to be the most prominent approaches for addressing the leading operational problems in EDs. In future interventions, ED administrators and researchers are widely advised to combine Operations Research (OR) methods, quality-based techniques, and data-driven approaches for upgrading the performance of EDs. On a different tack, more interventions are required for tackling overcrowding and high left-without-being-seen rates.

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Using Lean Management to Reduce Emergency Department Length of Stay for Medicine Admissions

Abstract: We utilized Lean management to significantly reduce ED LOS for medicine admissions. Specifically, the development and management of standard work were key to sustaining these results.

Cited by 26 publications

References 16 publications

SurgeCon: Priming a Community Emergency Department for Patient Flow Management

SurgeCon: Priming a Community Emergency Department for Patient Flow Management

Interventions to reduce emergency department consultation time: A systematic review of the literature

Methodological Approaches to Support Process Improvement in Emergency Departments: A Systematic Review

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