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

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.

scholarly journals Application of Lean Six Sigma to Improve Service in Healthcare Facilities Management: A Case Study

2017 ◽  
Vol 1 (1) ◽  
pp. 9-18 ◽  
Author(s):  
Will T. Shirey ◽  
Kenneth Timothy Sullivan ◽  
Brian Lines ◽  
Jake Smithwick
Keyword(s):  
Quality Improvement ◽  
Six Sigma ◽  
Healthcare Organization ◽  
Research Literature ◽  
Lean Six Sigma ◽  
Facilities Management ◽  
Post Intervention ◽  
Healthcare Facilities ◽  
Computerized Maintenance Management System

ABSTRACT The purpose of this paper is to present a case study on the application of the Lean Six Sigma (LSS) quality improvement methodology to facilities management (FM) services at a healthcare organization. Research literature was reviewed concerning whether or not LSS has been applied in healthcare-based FM, but no such studies have been published. This paper aims to address the lack of an applicable methodology for LSS intervention within the context of healthcare-based FM. The Define, Measure, Analyze, Improve, and Control (DMAIC) framework was followed to test the hypothesis that LSS can improve the service provided by an FM department responsible for the maintenance and repair of furniture and finishes at a large healthcare organization in the southwest United States of America. Quality improvement curricula and resources offered by the case study organization equipped the FM department to apply LSS over the course of a five-month period. Qualitative data were gathered from pre- and post-intervention surveys while quantitative data were gathered with the Organization's computerized maintenance management system (CMMS) software. Overall, LSS application proved to be useful for the intended purpose. The authors proposes that application of LSS by other FM departments to improve their services could also be successful, which is noteworthy and deserving of continued research.

scholarly journals Impact of process improvements on measures of emergency department efficiency

CJEM ◽  
2016 ◽  
Vol 19 (2) ◽  
pp. 96-105 ◽  
Author(s):  
Alexander K. Leung ◽  
Shawn D. Whatley ◽  
Dechang Gao ◽  
Marko Duic
Keyword(s):  
Emergency Department ◽  
Patient Flow ◽  
Interrupted Time Series ◽  
Initial Assessment ◽  
Interrupted Time Series Analysis ◽  
Post Intervention ◽  
Process Improvements ◽  
Left Without Being Seen ◽  
Clinically Significant ◽  
The Impact

AbstractObjectiveTo study the operational impact of process improvements on emergency department (ED) patient flow. The changes did not require any increase in resources or expenditures.MethodsThis was a 36-month pre- and post-intervention study to evaluate the effect of implementing process improvements at a community ED from January 2010 to December 2012. The intervention comprised streamlining triage by having patients accepted into internal waiting areas immediately after triage. Within the ED, parallel processes unfolded, and there was no restriction on when registration occurred or which health care provider a patient saw first. Flexible nursing ratios allowed nursing staff to redeploy and move to areas of highest demand. Last, demand-based physician scheduling was implemented. The main outcome was length of stay (LOS). Secondary outcomes included time to physician initial assessment (PIA), left-without-being-seen (LWBS) rates, and left-against-medical-advice (LAMA) rates. Segmented regression of interrupted time series analysis was performed to quantify the impact of the intervention, and whether it was sustained.ResultsPatients totalling 251,899 attended the ED during the study period. Daily patient volumes increased 17.3% during the post-intervention period. Post-intervention, mean LOS decreased by 0.64 hours (p<0.005). LOS for non-admitted Canadian Triage and Acuity Scale 2 (-0.58 hours, p<0.005), 3 (-0.75 hours, p<0.005), and 4 (-0.32 hours, p<0.005) patients also decreased. There were reductions in PIA (43.81 minutes, p<0.005), LWBS (35.2%, p<0.005), and LAMA (61.9%, p<0.005).ConclusionA combination of process improvements in the ED was associated with clinically significant reductions in LOS, PIA, LWBS, and LAMA for non-resuscitative patients.

scholarly journals Zap it track it: the application of Lean Six Sigma methods to improve the screening system of low-grade mucinous neoplasms of the appendix in an acute hospital setting

2019 ◽  
Author(s):  
kathleen McGrath ◽  
Mairéad Casserly ◽  
Freda O’mara ◽  
Jurgen Mulsow ◽  
Conor Shields ◽  
...  
Keyword(s):  
Six Sigma ◽  
Lean Six Sigma ◽  
Acute Hospital ◽  
Tumour Markers ◽  
Low Grade ◽  
Screening System ◽  
Post Intervention ◽  
Number Of Patients ◽  
Mucinous Neoplasms

Abstract Objective To improve the number of patients receiving annual computed tomography (CT) scan and tumour markers, who are diagnosed with low-grade mucinous neoplasms (LAMN). Design A pre-/post-intervention design was employed using Lean Six Sigma methods to identify gaps in the screening system and to develop and implement solutions for a more robust, auditable screening programme. Setting The patients diagnosed with LAMN of the appendix referred to the acute hospital and are enrolled in the screening service. Participants Consultant colorectal surgeons, cancer nurse specialist, colorectal medical team and quality improvement staff. Interventions Diagnostic tools identified gaps in the current process. A set of improvements were implemented to standardize the pathway for referral and surveillance of patients, provide information on the condition and treatment and standardize and track information received by patients and their referring hospital. Main Outcome Measure(s) Pre and post-intervention outcome measures were taken for the number of patients who receive an annual CT of thoracic, abdomen and peritoneum and tumour markers and number of patients who receive information and contact details. Results At baseline, of the 28 patients that met the inclusion criteria only 61% had a correct follow-up. Following the implementation of improvements, 78% of patients had correct follow-up and 90% had received information. Conclusions Gaps in the current cancer screening system were identified and improvements implemented a reduced number of patients having an incorrect follow-up. Findings are applicable across all precancerous screening systems irrespective of the type of malignancy. The methods used empowered patients and fostered an interdisciplinary team approach to care.

Patient Flow Optimization Using Knowledge Supernetworks and Lean Six Sigma

2016 ◽  
pp. 232-237 ◽  
Author(s):  
Chiara Cirrone ◽  
Eleonora Di Pietro ◽  
Aurelio La Corte ◽  
Alfina A. Torrisi
Keyword(s):  
Six Sigma ◽  
Patient Flow ◽  
Lean Six Sigma ◽  
Flow Optimization ◽  
Patient Flow Optimization

scholarly journals PL003: Impact of process improvements on measures of emergency department efficiency

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S29-S30
Author(s):  
A. Leung ◽  
M. Duic ◽  
D. Gao ◽  
S. Whatley
Keyword(s):  
Emergency Department ◽  
Patient Flow ◽  
Retrospective Chart Review ◽  
Interrupted Time Series ◽  
Initial Assessment ◽  
Interrupted Time Series Analysis ◽  
Post Intervention ◽  
Process Improvements ◽  
Secondary Outcomes ◽  
Physician Scheduling

Introduction: The objective was to study the operational impact of an intervention comprised of simultaneous process improvements to triage, patient inflow, and physician scheduling patterns on emergency department (ED) patient flow. The intervention did not require any increase in ED resources or expenditures. Methods: A 36-month pre-/post-intervention retrospective chart review at an urban community emergency department from January 2010 to December 2012. The ED process improvements started on June 6, 2011 and involved streamlining triage, parallel processing, flexible nurse-patient ratios, flexible exam spaces, and flexible physician scheduling. The main outcomes were ED length-of-stay (LOS). Secondary outcomes included time to physician-initial-assessment (PIA), left-without-being-seen (LWBS) rates, and left-against-medical-advice (LAMA) rates. Segmented regression of interrupted time series analysis was performed on Canadian Triage and Acuity Scale (CTAS) 2 to 5 patients to quantify the immediate impact of the intervention on the outcome levels, and whether there were changes in the trend between pre-intervention and post-intervention segments. Results: 251,899 patients attended the ED during the study period. Daily patient volumes increased 17.3% during the post-intervention period. Post-intervention, for CTAS 2-5 patients, there was a reduction in average LOS by 0.64 hours (p<0.001), and 90th-percentile LOS by 0.81 hours (p=0.024). When separated by acuity and disposition, there were reductions in LOS for non-admitted CTAS 2 (-0.58 hours, p <0.001), 3 (-0.75 hours, p <0.001), 4 (-0.32 hours, p=0.002), and 5 (-0.28 hours, p=0.008) patients. For secondary outcomes, there was a decrease in overall average PIA by 43.81 minutes (p<0.001), and 90th-percentile PIA by 91.39 minutes (p<0.001). LWBS and LAMA rates decreased by 35.2% (p<0.001) and 61.9% (p<0.001), respectively. Conclusion: A series of process improvements meant to optimize flow in the ED without the addition of resources was associated with clinically significant reductions in LOS, PIA, LWBS and LAMA rates for non-resuscitative patients.

scholarly journals LO009: Impact of physician navigators on measures of emergency department efficiency

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S33-S33
Author(s):  
A. Leung ◽  
Z. Gong ◽  
B. Chen ◽  
M. Duic
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Patient Flow ◽  
High Volume ◽  
Physician Satisfaction ◽  
Intervention Period ◽  
Post Intervention ◽  
Post Intervention Period ◽  
Secondary Outcomes ◽  
Very High

Introduction: The Physician Navigator (PN) is a novel position created to manage patient flow in real-time at a very-high volume emergency department (ED). When paired with an emergency physician, PNs actively track patient wait times, and direct the physician to see and re-assess patients in a particular order to improve measures of emergency department efficiency, and maximize patient flow. Anecdotal evidence has shown that PNs decrease length-of-stay times for non-resuscitative patients in the setting of increased patient volumes, and without additional nursing or physician hours. The objective was to study the operational impact of PN on emergency department patient flow. Methods: A 48-month pre-/post-intervention retrospective chart review at an urban community emergency department from September 2011 to September 2015. The PN program started on March 1, 2013. The main outcome is emergency department length-of-stay (LOS). Secondary outcomes include time to physician-initial-assessment (PIA), left-without-being-seen rates (LWBS), left-against-medical-advice (LAMA), and physician satisfaction rates. Autoregressive integrated moving average models were generated for Canadian Triage and Acuity Scale (CTAS) 2 to 5 patients to quantify the immediate impact of the intervention on the outcome levels, and whether the impact was sustained over time. Results: Interim results are provided. 399,958 patients attended the ED during the study period. Daily patient volumes increased 11.2% during the post-intervention period. There were no significant increases in the number of physicians shifts/day, and physician hours/day during the post-intervention period. Post-intervention, for CTAS 2-5 patients, there was a reduction in average LOS by 0.04 hours/PN (p<0.05), and 90th-percentile LOS by 0.14 hours/PN (p<0.05). For secondary outcomes, there was a decrease in overall average PIA by 6.37 minutes/PN (p<0.05), and 90th-percentile PIA by 8.29 minutes/PN (p<0.05). LWBS rates decreased by 40.8% (p<0.05). There were no significant changes in LAMA rates. Conclusion: The implementation of Physician Navigators is associated with significant reductions in LOS, PIA, and LWBS rates for non-resuscitative patients at a very-high volume emergency department.

Using Lean Six Sigma to Accelerate Emergency Department Results

2009 ◽  
pp. 31-53
Author(s):  
Greg Butler ◽  
Chip Caldwell ◽  
Shannon Elswick
Keyword(s):  
Emergency Department ◽  
Six Sigma ◽  
Lean Six Sigma
Sign in / Sign up

Export Citation Format

Share Document