Dissecting delays in trauma care using corporate lean six sigma methodology

Area of Science:

• Emergency Medicine
• Healthcare Management
• Process Improvement

Background:

• Trauma center overcrowding is a critical issue identified by the Institute of Medicine.
• Patient dwell times in trauma resuscitation units (TRU) contribute significantly to overcrowding.
• Quantifying and reducing TRU dwell times is essential for improving patient flow and capacity.

Purpose of the Study:

• To apply Lean Six Sigma methodology to reduce overcrowding in trauma centers.
• To quantify patient dwell times in trauma resuscitation units (TRU).
• To identify specific opportunities for reducing TRU dwell times.

Main Methods:

• Prospective measurement of TRU dwell time for 1,184 trauma patients over 3 months.
• Definition of delays as TRU dwell time exceeding 6 hours.
• Process mapping and time studies using Lean Six Sigma principles to analyze patient flow.

Main Results:

• 15% of trauma patients experienced TRU delays (183 of 1,184).
• Delays occurred even on days with fewer than 15 patients, indicating systemic issues.
• Lean Six Sigma mapping identified four key processes contributing to TRU delays.

Conclusions:

• Lean Six Sigma methodology effectively identified opportunities to reduce TRU dwell times.
• Reducing TRU dwell time by 1 hour per patient can increase TRU capacity.
• Optimizing operational efficiency through dwell time reduction is crucial for managing overcrowding in trauma centers.