Using LEAN to Improve a Segment of Emergency Department Flow

Vose, Courtney; Reichard, Christine; Pool, Susan; Snyder, Megan; Burmeister, David B.

doi:10.1097/nna.0000000000000098

Cited by 18 publications

(18 citation statements)

References 1 publication

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“…Moreover, the turnaround time (TAT) decreased in the five studies that addressed it. Boarding time was only evaluated in four LH interventions, with better results in all of them [ 3 , 19 , 29 , 91 ].…”

Section: Resultsmentioning

confidence: 99%

Assessing the Impact of Lean Healthcare on Inpatient Care: A Systematic Review

Zepeda-Lugo

Tlapa

Báez-López

et al. 2020

IJERPH

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Healthcare services are facing challenges in increasing their efficiency, quality of care, and coping with surges in demand. To this end, some hospitals have implemented lean healthcare. The aim of this systematic review is to evaluate the effects of lean healthcare (LH) interventions on inpatient care and determine whether patient flow and efficiency outcomes improve. The review was performed according to PRISMA. We used six databases to search for studies published from 2002 to 2019. Out of 5732 studies, 39 measuring one or more defined outcomes were included. Hospital length of stay (LOS) was measured in 23 studies, 16 of which reported a reduction, turnover time (TOT) decreased in six out of eight studies, while the turnaround time (TAT) and on-time starts (OTS) improved in all five and seven studies, respectively. Moreover, eight out of nine studies reported an earlier discharge time, and the boarding time decreased in all four cases. Meanwhile, the readmission rate did not increase in all nine studies. Lastly, staff and patient satisfaction improved in all eight studies. Our findings show that by focusing on reducing non-value-added activities, LH contributed to improving patient flow and efficiency within inpatient care.

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Section: Resultsmentioning

confidence: 99%

Assessing the Impact of Lean Healthcare on Inpatient Care: A Systematic Review

Zepeda-Lugo

Tlapa

Báez-López

et al. 2020

IJERPH

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“…A major strength of this trial is the use of a stepped wedge cluster randomised controlled trial design, an emerging trial design in health service delivery evaluations that offers several benefits over other parallel cluster designs [ 26 , 38 ]. The rigour of this method and the involvement of multiple sites offers clear advantages over other commonly used methods for evaluation of patient flow or waiting list interventions, such as single-site studies [ 23 , 39 ], quality improvement methods [ 40 , 41 ] or retrospective analyses of health service datasets [ 42 , 43 ]. The ICC for the primary outcome of waiting time was larger than hypothesised in our sample size estimation ( ρ = 0.058 versus ρ = 0.01) [ 27 ], possibly due to greater variability than expected between sites.…”

Section: Discussionmentioning

confidence: 99%

A model of access combining triage with initial management reduced waiting time for community outpatient services: a stepped wedge cluster randomised controlled trial

Harding

Leggat

Watts

et al. 2018

BMC Med

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BackgroundLong waiting times are associated with public community outpatient health services. This trial aimed to determine if a new model of care based on evidence-based strategies that improved patient flow in two small pilot trials could be used to reduce waiting time across a variety of services. The key principle of the Specific Timely Appointments for Triage (STAT) model is that patients are booked directly into protected assessment appointments and triage is combined with initial management as an alternative to a waiting list and triage system.MethodsA stepped wedge cluster randomised controlled trial was conducted between October 2015 and March 2017, involving 3116 patients at eight sites across a major Australian metropolitan health network.ResultsThe intervention reduced waiting time to first appointment by 33.8% (IRR = 0.663, 95% CI 0.516 to 0.852, P = 0.001). Median waiting time decreased from a median of 42 days (IQR 19 to 86) in the control period to a median of 24 days (IQR 13 to 48) in the intervention period. A substantial reduction in variability was also noted. The model did not impact on most secondary outcomes, including time to second appointment, likelihood of discharge by 12 weeks and number of appointments provided, but was associated with a small increase in the rate of missed appointments.ConclusionsBroad-scale implementation of a model of access and triage that combined triage with initial management and actively managed the relationship between supply and demand achieved substantial reductions in waiting time without adversely impacting on other aspects of care. The reductions in waiting time are likely to have been driven, primarily, by substantial reductions for those patients previously considered low priority.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12615001016527 registration date: 29/09/2015.

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“…Reasons for this mindset are varied: an ED physician may feel that he/she has more patients, has sicker patients, or has picked up the most recent chart. With segmentation of the ED, positive changes might improve the flow of patients: the communication between nurses and physicians may be improved because the nurses know which physician is in charge of a particular patient; the size of each physician’s area of care is smaller, meaning less walking; and the physician now has full responsibility in his/her area [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

The impact of emergency department segmentation and nursing staffing increase on inpatient mortality and management times

Claret

Bobbia

Olive

et al. 2016

BMC Health Serv Res

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BackgroundThe aim of our study was to investigate the impact of a new organization of our emergency department (ED) on patients’ mortality and management delays.MethodsThe ED segmentation consisted of the development of a new patient care geographical layout on a pre-existing site and changing the organization of patient flow. It took place on May 10, 2012. We did a before-after study in the ED of a university hospital, “before” (winter 2012) and “after” (summer 2012) reorganization by segmentation into sectors. All ED patients were included.ResultsEighty-three thousand three hundred twenty-two patient visits were analyzed, 61,118 in phase “before”, 22,204 during the phase “after”. The overall inpatient mortality was 1.5 % during summer 2011 (“before” period), 1.8 % during winter 2012 (“before” period), 1.3 % during summer 2012 (“after” period) period (summer 2012 vs. winter 2012, OR = 0.72; 95 % CIs [0.61, 0.85], and summer 2012 vs. summer 2011, OR = 0.85; 95 % CIs [0.72, 0.99]). The mean (SD) time to first medical contact was 129 min (±133) during winter 2012 and 104 min (± 95) during summer 2012 (p < .05).ConclusionsOur study showed a decrease in mortality and improvement in time to first medical contact after the segmentation of our ED and nursing staffing increase, without an increase in medical personnel. Improving patient care through optimizing ED segmentation may be an effective strategy.

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Using LEAN to Improve a Segment of Emergency Department Flow

Cited by 18 publications

References 1 publication

Assessing the Impact of Lean Healthcare on Inpatient Care: A Systematic Review

Assessing the Impact of Lean Healthcare on Inpatient Care: A Systematic Review

A model of access combining triage with initial management reduced waiting time for community outpatient services: a stepped wedge cluster randomised controlled trial

The impact of emergency department segmentation and nursing staffing increase on inpatient mortality and management times

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