Improvement of emergency department patient flow using lean thinking

Area of Science:

• Emergency Medicine
• Healthcare Management
• Process Improvement

Background:

• Emergency departments (EDs) face challenges with patient flow and waiting times.
• Triage acuity level-3 patients represent a significant portion of ED visits.
• Optimizing ED operations is crucial for patient care and resource management.

Purpose of the Study:

• To implement lean thinking principles for triage acuity level-3 patients.
• To enhance emergency department (ED) throughput and reduce patient waiting times.
• To evaluate the impact of lean methodology on key ED performance indicators.

Main Methods:

• A prospective interventional study was conducted in a tertiary care hospital's ED.
• Lean techniques including value stream mapping and waste reduction were applied by frontline staff.
• Data from pre-lean (April-September 2015) and post-lean (April-September 2016) periods were compared.

Main Results:

• Despite an 8.3% increase in daily visits, process times for discharged and observation patients decreased significantly.
• Median length of stay reduced from 389 to 329 minutes (P < 0.001).
• Median waiting time decreased from 71 to 48 minutes (P < 0.001), with no significant changes in left-without-being-seen, revisit, or mortality rates.

Conclusions:

• Lean thinking is an effective methodology for improving patient flow in EDs.
• Implementation of lean principles can lead to enhanced throughput and reduced waiting times for triage acuity level-3 patients.
• The study demonstrates successful application of lean techniques without additional resources.