ED Patient Flow: Utilizing the Six Sigma Approach to Reduce Emergency Department Overcrowding

Because of increased competition between healthcare providers, higher customer expectations, stringent checks on insurance payments and new government regulations, it has become vital for healthcare organisations to enhance the quality of the care they provide, to increase efficiency, and to improve the cost effectiveness of their services. Consequently, a number of quality management concepts and tools are employed in the healthcare domain to achieve the most efficient ways of using time, manpower, space and other resources. Emergency departments are designed to provide a high-quality medical service with immediate availability of resources to those in need of emergency care. The challenge of maintaining a smooth flow of patients in emergency departments is a global problem. This study attempts to improve the patient flow in emergency departments by considering Lean techniques and Six Sigma methodology in a comprehensive conceptual framework. The proposed research will develop a systematic approach through integration of Lean techniques with Six Sigma methodology to improve patient flow in emergency departments. The results reported in this paper are based on a standard questionnaire survey of 350 patients in the Emergency Department of Aseer Central Hospital in Saudi Arabia. The results of the study led us to determine the most significant variables affecting patient satisfaction with patient flow, including waiting time during patient treatment in the emergency department; effectiveness of the system when dealing with the patients complaints; and the layout of the emergency department. The proposed model will be developed within a performance evaluation metric based on these critical variables, to be evaluated in future work within fuzzy logic for continuous quality improvement.

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The Use of Lean Six Sigma for Improving Availability of and Access to Emergency Department Data to Facilitate Patient Flow

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph182111030 ◽

2021 ◽

Vol 18 (21) ◽

pp. 11030

Author(s):

Ailish Daly ◽

Seán Paul Teeling ◽

Marie Ward ◽

Martin McNamara ◽

Ciara Robinson

Keyword(s):

Emergency Department ◽

Data Management ◽

Six Sigma ◽

Patient Flow ◽

Hospital Management ◽

Lean Six Sigma ◽

Data Availability ◽

Diagnostic Tools ◽

Post Intervention ◽

Service Staff

The aim of this study was to redesign an emergency department [ED] data management system to improve the availability of, and access to, data to facilitate patient flow. A pre-/post-intervention design was employed using Lean Six Sigma methodology with a focus on the voice of the customer, Gemba, and 5S to identify areas for improvement in ED data management processes and to inform solutions for improved ED patient flow processes. A multidisciplinary ED team includes medical consultants and registrars, nurses, patient service staff, radiology staff, as well as information technology and hospital management staff. Lean Six Sigma [LSS] diagnostic tools identified areas for improvement in the current process for data availability and access. A set of improvements were implemented to redesign the pathway for data collection in the ED to improve data availability and access. We achieved a reduction in the time taken to access ED patient flow data from a mean of 9 min per patient pre-intervention to immediate post-intervention. This enabled faster decision-making by the ED team related to patient assessment and treatment and informed improvements in patient flow. Optimizing patient flow through a hospital’s ED is a complex task involving collaboration and participation from multiple disciplines. Through the use of LSS methodology, we improved the availability of, and fast access to, accurate, current information regarding ED patient flow. This allows ED and hospital management teams to identify and rapidly respond to actions impacting patient flow.

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Analyzing the waiting time pattern for non-critical patients in the emergency department using six sigma approach

10.1063/1.4801305 ◽

2013 ◽

Author(s):

Noriza Majid ◽

Nur Riza Mohd Suradi ◽

Safura Ahmad Sabri

Keyword(s):

Emergency Department ◽

Waiting Time ◽

Six Sigma ◽

Time Pattern ◽

Critical Patients ◽

Six Sigma Approach

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Pediatric Emergency Department Overcrowding and Impact on Patient Flow Outcomes

Academic Emergency Medicine ◽

10.1111/j.1553-2712.2008.00224.x ◽

2008 ◽

Vol 15 (9) ◽

pp. 832-837 ◽

Cited By ~ 59

Author(s):

Nathan L. Timm ◽

Mona L. Ho ◽

Joseph W. Luria

Keyword(s):

Emergency Department ◽

Patient Flow ◽

Pediatric Emergency ◽

Pediatric Emergency Department ◽

Emergency Department Overcrowding

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(A122) Using Focused Operations Management Tools to Analyze and Alleviate Emergency Department Overcrowding

Prehospital and Disaster Medicine ◽

10.1017/s1049023x11001233 ◽

2011 ◽

Vol 26 (S1) ◽

pp. s34-s35 ◽

Cited By ~ 1

Author(s):

D. Schwartz ◽

B. Ronen ◽

J.S. Pliskin ◽

A. Goldberg

Keyword(s):

Emergency Department ◽

Operations Management ◽

Medical Center ◽

Patient Flow ◽

Care Quality ◽

Patient Comfort ◽

Electronic Patient Records ◽

Affecting Factors ◽

Emergency Department Overcrowding ◽

The Impact

IntroductionEmergency department overcrowding plagues departments worldwide with grave implications on patient comfort and care quality. Many standard approaches have been introduced without widespread success. A new approach is required. Focused Operations Management (FM) integrates novel managerial theories and practical tools into a systematic approach to complex systems, promoting insight and improving performance. It has allowed systems in the industry and service sectors to radically improve throughput and quality with no or little additional cost. The implementation of the FM in the emergency department setting to alleviate overcrowding has never been attempted, and it could revolutionize emergency department operations management.MethodsEmergency department patient flow data affecting factors and outcomes from a large tertiary medical center, exclusively utilizing electronic patient records, will be collected. Root causes and influencing variables of emergency department overcrowding will be mapped and analyzed using FM tools. Later, alleviating measures will be developed and evaluated. During phase two, data will be collected from two additional emergency departments, measuring the impact of implementation of FM operational changes on emergency department flow parameters such as length of stay, wait times, clinical outcomes, and patient and staff satisfaction.ResultsData collection and analysis of phase one of the study will be completed by March 2011 and presented at the conference. The authors speculate that the FM tools will allow better understanding of the root causes and affecting variables of emergency department overcrowding and help plan and later implement efficient interventions.DiscussionThe implementation of the novel management strategies of FM has revolutionized operations in many industries and services, helping them to drastically improve performance. The emergency department is a perfect candidate for the use of these tools, due to the overwhelming current operational difficulties (with overcrowding as a prominent symptom) and its complex high volume and high acuity patient flow.

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Improving patient flow through applying lean concepts to emergency department

Leadership in Health Services ◽

10.1108/lhs-02-2018-0014 ◽

2018 ◽

Vol 31 (3) ◽

pp. 293-309 ◽

Cited By ~ 4

Author(s):

Hossam Elamir

Keyword(s):

Emergency Department ◽

Patient Flow ◽

Process Reengineering ◽

Care Hospital ◽

Gulf Region ◽

Content Type ◽

Emergency Department Overcrowding ◽

Global Issues ◽

Flow Through ◽

Ed Visits

Purpose This paper aims to propose lean-based interventions that address the main causes of emergency department overcrowding. Emergency department overcrowding (EDOC) and increased length of stay (LOS) have been key global issues for more than 20 years, as they have serious repercussions. No measurements have been done to assess the situation nationally. Expanding emergency departments (EDs) and adding more beds have never succeeded in eliminating wastes and targeting the root causes of the problem. Design/methodology/approach This paper is a quantitative analytical applied research. The paper used direct observation for seven days to collect patient flow data on ED patients at a secondary care hospital in Kuwait. It calculated wait times and services to identify the major causes of EDOC and increased LOS. Findings Around one-third of the ED design capacity was used by 12 per cent of the patients who stayed >6 h each. The wasted waiting time represents 56.2 per cent of the aggregated LOS, which puts lean management (LM) on the top of the process reengineering approaches suitable for improving overcrowding by reducing waste. Guided by the LM concepts, the paper proposes solutions that fall into three themes. The selected solutions address the vital few causes of the EDOC and prolonged EDLOS. Originality/value This paper is the first study of its kind in Kuwait, and one of the most outstanding studies in the Gulf region, in terms of the number of the daily ED visits and the comprehensive multi-level proposed interventions.

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