1Improving Patient Flow in the Emergency Department

By Tina Dauzat

ED Lean Project Overview2

GoalImprove ED patient throughput in a rural community hospital

BackgroundRecent $10M renovation of ED to update facility and increase capacity to 25 ED beds

Volume120-170 ED patients/day

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How long do

YOUexpect to wait before being

seen in the ER?

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54 minutes

Patients were waiting 54 minuteson average to be seen and taken to a bed

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Welcome to theER, how can wehelp you today?

Goal:

Turn ED waiting room into a Greeting room

Goal:

Turn ED waiting room into a Greeting room

Lean event was held to reduce

patient wait times

Future State

Value Stream

Map

Lean Event

May 2009

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Actions Taken7

� Move desk to lobby

� Staff desk with RN and clerk

� Perform triage and bed placement from lobby

� Perform registration at the bedside

Arrival to Bed Time

Improved by 72%8

72%

improvement

Avg 54 min

Avg 15 min

lean event

What are benefits of improving

arrival to bed wait time?

Your ideas?

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Arrival to Physician Greet Time

Improved by 52%10

52%

improvement

Avg 67 min

Avg 32 min

lean event

What are the benefits of improving

bed to greet time?

Your ideas?

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That’s good, but . . .

We still have some work to do12

Pre Lean Event Post Lean Event

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People are still waiting, but now they are waiting in beds and hallways

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Back to the

Drawing Board

Opportunity Statement:

Provide a high quality patient experience in a consistent, timely manner, while continually minimizing waste and effort, from the time the patient is placed in the bed until disposition in the ED

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Interviewed Key Staff and Observed Work

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Planned 3 Day Lean Event

Time Tuesday Wednesday Thursday

8:00 Introductions & CEO Address

8:30 Scope/Metrics

9:00

9:30

10:00 15 m Break/Q&A

10:30

11:00

11:30

12:00 Lunch Lunch Lunch

12:30 Project Suggestions and Report

1:00

1:30

2:00 15 m Break/ CSM revision

2:30

3:30

4:00 Report Out Report Out

4:30 Follow-up from Report Out Follow-up from Report Out

5:00 Parking Lot, Wed Pre-work Follow-up from Report Out

6:30

7:30

8:30 Parking Lot, Thurs pre-work

Who:

Team members, O level for

report out, ED Directors, Brett,

Mary, MG

Team members, O level for report

out, ED Directors, Brett, Mary, MG

Team members, O level for

report out, ED Directors, Brett,

Mary, MG

(Dinner) OBS in Lab/Img/Pharm

Future State Map

Validate FSM in ED

Pilot changes in ED/Lab/Pharm

Countermeasures Accountability

Report Out

CSM Validation (in ED)

Prep for Report Out

Modified Team Stepps

VSM Validation (in ED)

VSM Validation (in ED)

Consolidation of VSM

A3-Tool Kit

Current State Map

3-Day Lean Agenda

Another lean event was held to reduce

greet to dispo wait times

Team

Members

Lean Event

Sept 2010

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Got Waste?

Motion Moving charts between desks

Rework Unable to collect acceptable blood sample

Rework Unlabeled specimens

Waiting Unable to collect urine sample

Over Production Re-stick patient multiple times due to hard stick

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Only 24% of the current state process were considered value added tasks

76% of tasks fell into the non-valued added categories (waste)

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Guided Teams inDevelopingFuture State

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Value-Added %Current State 24%Future State 74%

Current Struggles

� Volume arrival

� ED max capacity and

Hospital max capacity

� Acuity levels vary

� Provider process

varies

� Communication to

ancillary depts.

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Implementing Change23

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Empty Waiting Rooms

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Speedy Assessment

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Patient Centric

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Fast AccurateTreatment

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How does that sound?

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Start Small