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Using lean-based systems engineering to increase capacity in the emergency department.

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Lean process improvements in emergency departments (EDs) significantly reduced patient length of stay (LOS) and exam room time. This study demonstrates enhanced ED throughput and capacity without additional costs.

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Area of Science:

  • Systems engineering
  • Healthcare operations research
  • Process improvement methodologies

Background:

  • Emergency department (ED) crowding is a significant issue with negative consequences.
  • Systems engineering and throughput optimization are potential solutions for increasing ED functional capacity.
  • Effective techniques for broad ED application remain unclear.

Purpose of the Study:

  • To test the hypothesis that Lean-based reorganization of Fast Track process flow can improve length of stay (LOS), the percentage of patients discharged within one hour, and room utilization.
  • To assess these improvements without incurring additional expenses.

Main Methods:

  • Prospective, controlled, before-and-after analysis of Fast Track process improvements.
  • Study conducted at a Level 1 tertiary care academic medical center with >95,000 annual visits.
  • Intervention involved reorganizing patient flow using systems engineering, queuing theory, demand-capacity matching, and Lean methodologies, with no changes to staffing or physical space.
  • Data collected from an electronic tracking system for adult patients during two 5-month periods (2010 and 2011).
  • Concurrent patients in another care area served as a control group.
  • Primary outcomes: LOS, percentage of patients discharged within one hour, and time in exam room.

Main Results:

  • Median LOS for discharged patients decreased by 15 minutes (158 to 143 min, p<0.0001).
  • The percentage of patients discharged within one hour increased by 2.8% (6.9% to 9.7%, p<0.0001).
  • Median exam room time decreased by 34 minutes (90 to 56 min, p<0.0001).
  • The control group showed no significant changes in LOS or discharge rate within one hour, and an increase in exam room time (p<0.0001).

Conclusions:

  • A focused Lean-based reorganization of patient flow effectively improved Fast Track ED performance measures and capacity.
  • These improvements were achieved without additional expense.
  • Widespread implementation of systems engineering principles could further enhance ED throughput and capacity.