scholarly journals POCT in Emergency Rooms: One Key Factor for Process Streamlining with Lean Management

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Verena Lindenau-Stockfisch ◽  
Julia Searle ◽  
Martin Möckel

Overcrowding is a common problem in Emergency Departments (ED) worldwide and has a negative impact on patient satisfaction and, more importantly, patient safety. So, the Emergency Department of the secondary-care hospital Paul Gerhardt Stift in Wittenberg, Germany, was faced with increasing numbers of patients. Lean management was introduced to analyse, optimise, and standardise ED processes. Consequently, a project group concentrated on “cycling muda” which is to identify waste and cost drivers along a representative patient path using one suitable Lean tool: mapping the current state in a value stream. As a result, it became clear that both patients and staff suffered from immense waiting times that lead to risky patient care and employee frustration. By subsequently eliminating the waste drivers and designing a high-quality patient flow process creating standards supported by state-of-the-art technology, the hospital’s ED turned into a streamlined department with reduced waiting times offering employees a satisfactory and modern workplace where patients benefit from first-class care.

2020 ◽  
Vol 13 (1) ◽  
Author(s):  
Haris Dwi Armyanto ◽  
Dwi Djumhariyanto ◽  
Santoso Mulyadi

CV.X merupakan salah satu perusahaan pengolahan sarden yang terletak di Banyuwangi. Pada proses produksi di perusahaan masih ditemukan beberapa pemborosan (waste). Untuk mengurangi pemborosan yang terjadi digunakan pendekatan lean manufacturing dengan metode Value Stream Mapping (VSM) untuk pemetaan aliran produksi dan aliran informasi terhadap proses produksi dari awal bahan baku hingga produk jadi dan dikirim ke konsumen, serta analisis dengan metode Failure Mode and Effects Analysis (FMEA) untuk mengetahui penyebab kegagalan proses yang paling prioritas dan perlu dilakukan perbaikan dengan segera. Identifikasi pemborosan diawali dengan penggambaran current state map, lalu dilakukan analisis pemborosan ke dalam kategori 7 pemborosan [1]. Pada analsis tersebut ditemukan 3 jenis pemborosan yaitu waiting time, unnecessary inventory dan defect (kembung). Setelah itu dilakukan analisis akar penyebab timbulnya pemborosan menggunakan fishbone diagram, dan analis FMEA untuk mengetahui nilai RPN tertinggi yang selanjutnya akan menjadi prioritas pemberian usulan perbaikan yang tepat dan sesuai dengan masalah dan kondisi proses produksi sarden 125g di CV.X. Rekomendasi perbaikan yang diberikan terhadap pemborosan dengan nilai RPN tertinggi antara lain Menambahkan mesin pencuci produk untuk mengurangi penumpukan produk dan waktu tunggu yang ada sehingga pemborosan waiting time dan unnecessary inventory dapat berkurang, mengganti sarung tangan kain dengan lateks, serta menjaga kebersihan nampan ikan. CV.X is a sardine processing company located in Banyuwangi. In the company production process there are some wastes. To reduce the waste that occurs, lean manufacturing approach using Value Stream Mapping (VSM) method is used to map the production flow and information flow to the production process from the beginning of the raw material to the finished product and sent to consumers, as well as analysis using the Failure Mode and Effects Analysis (FMEA) method. ) to find out what causes the most priority process failures and needs immediate improvement. Waste identification is preceded by a depiction of the current state map, then waste analysis is conducted into category 7 waste. In this analysis, there are 3 types of waste, which are waiting time, unnecessary inventory and defects. After that an analysis of the root causes of waste occurs using fishbone diagrams, and FMEA analysts to find out the highest RPN value which will then be prioritized for giving recommendations for an appropriate improvement and in accordance with the problems and conditions of the 125g sardine production process in CV.X. Improvement recommendations given for waste with the highest RPN value include adding a product washer to reduce product buildup and waiting times so that waiting time and unnecessary inventory waste can be reduced, replacing cloth gloves with latex, and keeping the fish tray clean.


2021 ◽  
Vol 10 (1) ◽  
pp. e001179
Author(s):  
Ahmed Elkholi ◽  
Huda Althobiti ◽  
Jamal Al Nofeye ◽  
Mohamed Hasan ◽  
Ahmed Ibrahim

Long waiting times in the emergency department (ED) are associated with decreased patient satisfaction and increased morbidity and mortality. Triage may be a contributing factor to prolonged wait times in the ED. At Alhada Armed Forces Hospital (Taif, Saudi Arabia), patients other than level 1 and 2 on the Canadian Triage and Acuity Scale are requested to wait until triage. During peak hours (08:00−22:00), the waiting time prior to triage is prolonged, and several patients leave the ED before triage. In this project, a multidisciplinary team was assembled to revise patient flow from the time of arrival at the ED to the time of triage. Lean methodology was used to identify the redundancies and design a seamless flow process for ED patients. Through reorganising the triage area using minimal additional resources, the project team devised a novel floor plan for the triage area which provided a unique patient flow in the ED. The median patient wait time from arrival to triage was reduced from 27 min to 4.09 min and the percentage of patients leaving the ER before triage was reduced to 0%. This project is the first of its kind in Saudi Arabia, as well as in the Gulf region, and provides a radical solution to the problem of patient waiting in the ED during peak hours.


BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S313-S313
Author(s):  
Maria Vittoria Capanna ◽  
Saima Ali ◽  
Robert Bates

AimsProlonged waiting times for admission to psychiatric hospital settings are a common and widespread issue. Delayed admissions may result in poorer outcomes due to prolonged mental suffering and delays in initiating treatment. Long waiting times also have a negative impact at a service level, impeding patient flow.National guidance has been recently updated, recommending that patient transfers to secure services take no longer than 28 days from referral. These transfers are frequently affected by delays in admission, possibly resulting in increased risk to patients, staff and the public.The aim of this project was to audit all referrals to Broadmoor High Secure Hospital in England within a one year period with special focus taken on calculating the time taken from referral to admission. We aimed to assess if there were any rate limiting steps which could be targeted to reduce time from referral to admission.MethodWe collected data and conducted a retrospective cohort review for all admissions from September 2019-September 2020. Where available, information was obtained for each step of the referrals process. Individual patient records were reviewed where required.Exclusion criteria: data withdrawn, transfers from other high secure services (HSS), incomplete data, “MOJ instruction” or urgent admission bypassing the process.Result18 cases were excluded as per exclusion criteria. 46 patients were included in the study. 16 referrals originated from medium secure psychiatric hospitals, and 30 from prison.The average time from referral to admission was 44.3 days. Admission of patients from MSUs was quicker, taking an average of 40.3 days when compared to prison referrals, which took 45.9 days.The breakdown of timings for each step in the referrals process was calculated to determine if a rate limiting step could be identified.On average it took 2.1 working days to allocate a case to a clinician, 7.6 days for an assessment, 9.2 days to complete a report and 3.5 days to submit this to the admissions panel. The mean time from referral to the date of the panel hearing was 22.5 working days, and admission took a further 21.8 days on average.ConclusionThe current average time to admission exceeds the new 28 day recommendation. This could both be due to the COVID-19 pandemic, and miscommunication about time targets. We will review the process and aim to reduce the time from referral to admission in line with new guidance.


2020 ◽  
pp. 150-154
Author(s):  
Элмира Нуркулова

Аннотация: В современном развивающемся обществе все больше расширяется роль и значение информации. Информация становится ключевым фактором развития человеческой цивилизации. В этих условиях важное место в структуре личности принадлежит ее информационной культуре, предполагающей владение источниками информации, способностью к ее поиску и активному использованию в жизненных процессах. В овладении молодежью информационной культуры важная роль принадлежит вузам и вузовским библиотекам. В статье показаны актуальность рассматриваемой проблемы, значение этих факторов становлении информационной культуры молодых поколений в период получения высшего образования, когда идет формирование всей культуры личности в целом. Раскрывается содержание понятия информационной культуры, кратко характеризуется современное состояние формирования информационной культуры в вузах Кыргызстана, определяется роль вузовских библиотек в воспитании информационной культуры студентов. Ключевые слова: общество знаний, информационное общество, информация, образование, культура, информационная культура, вузы в процессе воспитания информационной культуры, библиотеки вузов и информационная культура студента. Аннотация: Адамзат цивилизациясынын өнүгүшүндө маалыматтык маданият негизги маанилүү фактор болуп саналат, маалыматтыктын маанилүүлүгү менен ролу азыркы өнүгүп жаткан заманбап билим коомунда дагы да кенен өнүгүүдө. Ушул шартта жеке адамдын структурасындагы маанилүү орду анын маалыматтык маданиятында, жашоо процессинде алдын ала берилген маалымат булактарынан, аны издөө жөндөмдүүлүгү менен жигердүү пайдалануусу керек. Студентердин маалыматтык маданиятын өздөштүрүүдөгү маанилүү ролу жогорку окуу жайларына жана жогорку окуу жайларынын китепканаларына таандык. Макалада каралган маселенин актуалдуулугу көрсөтүлөт, жеке адамдын маалыматтык маданиятына коюлган бул маанилүү факторлор азыркы муундагы жаштардын жогорку билим алуу мезгилинде толук калыптанат. Макалада маалыматтык маданиятка түшүнүк берилип, мазмуну ачылат, Кыргызстандын жогорку окуу жайларындагы азыркы заманбап маалыматтык маданиятынын калыптанышындагы абалын кыскача таржымалдап, студенттердин маалыматтык маданиятын тарбиялоодо жогорку окуу жайларынын китепканаларынын ролу аныкталат. Түйүндүү сөздөр: коомдук билим, маалыматтык коом, маалымат, билим, маданият, маалыматтык маданият, ЖОЖдордун окуу процессинде маалыматтык маданиятын тарбиялоо, жогорку окуу жайларынын китепканалары жана студенттин маалыматтык маданияты Abstract: In the modern developing knowledge society, the role and importance of information is expanding more and more, information is becoming a key factor in the development of human civilization. Under these conditions, an important place in the structure of the personality belongs to its information culture, which involves the possession of information sources, the ability to search for it and its active use in life processes. An important role in the mastery of information culture by young people belongs to universities and university libraries. The article shows the relevance of the problem, the importance of these factors in the formation of the information culture of young generations during the period of higher education, when the formation of the entire culture of the personality as a whole is in progress. The content of the concept of information culture is revealed, the current state of the formation of information culture in universities of Kyrgyzstan is briefly characterized, the role of university libraries in the education of students' information culture is determined. Key words: knowledge society, information society, information, education, culture, information culture, universities in the process of education of information culture, university libraries and student information culture.


2018 ◽  
Vol 42 (4) ◽  
pp. 438
Author(s):  
Kathryn Zeitz ◽  
Darryl Watson

Objective The aim of the paper was to describe a suite of capacity management principles that have been applied in the mental health setting that resulted in a significant reduction in time spent in two emergency departments (ED) and improved throughput. Methods The project consisted of a multifocal change approach over three phases that included: (1) the implementation of a suite of fundamental capacity management activities led by the service and clinical director; (2) a targeted Winter Demand Plan supported by McKinsey and Co.; and (3) a sustainability of change phase. Descriptive statistics was used to analyse the performance data that was collected through-out the project. Results This capacity management project has resulted in sustained patient flow improvement. There was a reduction in the average length of stay (LOS) in the ED for consumers with mental health presentations to the ED. At the commencement of the project, in July 2014, the average LOS was 20.5 h compared with 8.5 h in December 2015 post the sustainability phase. In July 2014, the percentage of consumers staying longer than 24 h was 26% (n = 112); in November and December 2015, this had reduced to 6% and 7 5% respectively (less than one consumer per day). Conclusion Improving patient flow is multifactorial. Increased attendances in public EDs by people with mental health problems and the lengthening boarding in the ED affect the overall ED throughput. Key strategies to improve mental health consumer flow need to focus on engagement, leadership, embedding fundamentals, managing and target setting. What is known about the topic? Improving patient flow in the acute sector is an emerging topic in the health literature in response to increasing pressures of access block in EDs. What does this paper add? This paper describes the application of a suite of patient flow improvement principles that were applied in the mental health setting that significantly reduced the waiting time for consumers in two EDs. What are the implications for practitioners? No single improvement will reduce access block in the ED for mental health consumers. Reductions in waiting times require a concerted, multifocal approach across all components of the acute mental health journey.


Author(s):  
Emilio Moretti ◽  
Elena Tappia ◽  
Martina Mauri ◽  
Marco Melacini

AbstractIn a context where companies are striving to produce highly customised goods in small batches and within short lead times, increasing attention is being put on the design and management of part feeding systems. This research is the first to model automated part feeding to supermarkets in a factory environment, considering an innovative technology called vertical robotic storage and retrieval systems. This technology allows automating the storage, picking, and internal transportation activities in an integrated process, thanks to rack-climbing robots roaming in both the shop floor and the storage racks. We develop an analytical model based on the queuing network approach to analyse the system performance, and we use it to perform numerical experiments and to evaluate the design trade-offs with reference to a real case in the automotive industry. Results show that an increase in the number of robots leads to better performance since the positive impact on the response time is stronger than the negative impact on the waiting times of robots at the supermarkets due to congestion. Furthermore, a configuration with multiple small supermarkets improves the efficiency of the replenishment process, compared to a setting with few big supermarkets.


2014 ◽  
Vol 474 ◽  
pp. 73-78
Author(s):  
Jan Vavruška ◽  
František Manlig ◽  
František Koblasa

The main focus when improving business processes is on the analysis of material flow. Thorough analysis of the information flow and associated information systems is still undervalued. Working with inaccurate and/or obsolete data leads to incorrect outputs that negatively affect the entire control process. Analysis of the state of material has to go hand in hand with the information analysis. A mini audit of the information flow and information system can be carried out, which follows the classic principles of VSM (Value stream mapping), in order to make an initial analysis of the information flow and information system. Information about the current state of the process together with a measure how well it is represented by the model in the information system can be obtained thanks to this mini-audit. This article focuses on this mini-audit and briefly describes the auditing process. The details of how to create VSM maps is discussed with the main focus on an information flow where the key elements are the inputs and the outputs of the job orders for planning and production management. Attention is also focused on the form of delays in discrete-event recording in the production process which appear in the information system.


2018 ◽  
Vol 7 (2.29) ◽  
pp. 219
Author(s):  
Zulfa Fitri Ikatrinasari ◽  
Dan Kosasih

PT. AEMI is one of the growing electronic component manufacturing company. By this time, Kaizen project has been run and managed to become a culture in PT AEMI. However, the project has not integrated, comprehensive and not yet has a long-term goals. Implementation of value stream mapping (VSM) in PT AEMI is expected to make Kaizen projects more focused and to produce increasing of the maximum efficiency. In addition, VSM Kaizen is believed to make the those programs more integrated, effective and comprehensive. This study aims to: (1) create a current state mapping in the Department of Quality Control PT. AEMI, (2) identify wastes in the Department of Quality Control PT.AEMI, (3) create a future state mapping at the Department of Quality Control PT. AEMI, (4) make a plan of improvement and analyzing the application. Stages of the study were as follows: (1) identification of work processes, (2) collect and analysis of work process time, (3) analysis of the current state mapping, (4) calculate of lead time and process time, (5) analysis of value added and non value-added activities, (6) analysis of wastes, (7) make a plan of future state mapping, (8) improvement design (improvement planning), (9) implementation of improvement, (10) analysis of the implementation of improvements. The results of this study are: 1) current state mapping at QC Department shows that the total lead time of 848 minutes where there is non-value added activity of 778 minutes. 2) identify waste on the handling process where the product movement from assembly to QC for 2 minutes, movement transactions from assembly to QC for 479 minutes and the waiting time at  inspection area for 727 minutes. 3) future state mapping at QC Department shows that the total lead time of 516.5 minutes where there is non-value added activity of 446.5 minutes. 4) the improvement to do is to change the lay out where final inspection is moved from QC to manufacturing so as to result in reduce of non-value added activity by 46%. 


Lately, value stream mapping (VSM) is integrated with tools and techniques that belong to other areas of knowledge such as risk management (RM). It is well known tool in showing the value, value stream and the flow which represents three of lean manufacturing (LM) principles. This integration, gives more benefit in covering two of VSM issues such as considering the variability and uncertainty of production processes. In this paper, a model named variable value stream mapping (V-VSM) that integrates the two was showed, explained and tested. The model helps to generate the VSM in a dynamic way with the identification of current and potential risks. These risks might happen in the future bringing a strong impact on not reaching the main objectives in the defined time and cost. The model has been tested by conducting a case study in food sector. A current state map was built using both models, traditional VSM and VVSM. The results showed the effect of variability and uncertainty on the total cycle time (CT) and lead time (LT) values, where the traditional VSM failed to show it by being a static tool. Comparing the results of both models show the differences in presenting the real state of manufacturing environment..


2020 ◽  
Vol 3 (4) ◽  
pp. 509-521
Author(s):  
Wresni Anggraini ◽  
Anifah Naswan Ilhamda

Standar pelayanan minimal rumah sakit tentang waktu tunggu untuk rawat jalan yang ditetapkan oleh Kemenkes Nomor. 129/Menkes/SK/II/2008 adalah tidak lebih dari 60 menit.  Masalah yang dihadapi oleh Poli Tulip Rumah Sakit X Pekanbaru adalah waktu menunggu pasien lebih dari 60 menit.  Tujuan dari penelitian ini adalah memberikan usulan perbaikan untuk mengurangi waktu tunggu pasien.. Metode yang digunakan pada penelitian ini adalah  lean healthcare menggunakan analisis Value Stream Mapping (VSM) untuk menentukan nilai Process Cycle Efficiency (PCE). Berdasarkan current state value stream mapping nilai PCE saat ini adalah 16,85%, ini berarti efisiensi lini pada Poli Tulip Rumah Sakit X Pekanbaru masih sangat rendah. Proses usulan perbaikan efisiensi lini dengan cara mengidentifikasi dan mengurangi non value added activity dan waste yang paling sering terjadi pada proses pelayanan pasien. Ditemukan waste yang berpengaruh menyebabkan waste delay adalah waste unnecessary movement dan lost oppurtunity to retain or win customers yaitu sebesar 22,11%. Untuk mencari akar penyebab waste dilakukan root cause analysis. Akar penyebab masalah dari waste yang terjadi di lini pelayanan pasien bersumber dari faktor individual pegawai dan manajerial Rumah Sakit. Simulasi future state value stream mapping dengan menggunakan ARENA dilakukan untuk menguji usulan perbaikan, didapatkan  nilai PCE harapan sebesar 36,18 %, yang berarti dengan usulan perbaikan yang diberikan telah meningkatkan efisiensi jalur layanan pasien di Poli Tulip sebesar 19,33%.


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