A LEAN Approach to Emergency Department Crowding in a Southern California Health System
Journal Title: Emergency Medicine – Open Journal - Year 2016, Vol 2, Issue 2
Abstract
Background: Emergency Department (ED) crowding has been proven to lead to longer length of stay (LOS) minutes per patient’s arrival. Within AHMC HealthSystem (AHMC) in Fiscal Year (FY) 2016, all facilities experienced a 6.3% census increase from 181,818 in FY 2015 to 193,215. The need for increased efficiency and effectiveness in meeting increased demand was recognized by health system and emergency department leadership. Objective: AHMC implemented an ED initiative task force of 5 goals for all facilities to follow and achieve by the end of Fiscal Year 2016. Methods: This initiative required all facilitiesʼ EDs to achieve door to doctor time <30 minutes, ancillary turnaround time (TAT) <60 minutes, total length of stay (LOS) <150 minutes, left without being seen (LWBS) <1%, and Emergency Department Patient Experience of Care (EDPEC) Top Box >70%. AHMC utilized prospective improvement process tools such as LEAN, monthly site visits, best practice and quality meetings, and social media reviews. AHMC implemented an internal centralized online data collection tool through all facilities and AHMC corporate with the ability to track Centers for Medicare and Medicaid Services (CMS) mandated metrics. Results: By the end of FY 2016, AHMC hospitals reduced their LOS from over 200 minutes to 180 minutes, LWBS rates decreased from 3-5% to less than 1%, door to doctor times decreased to an average of 31 minutes, and EDPEC satisfaction scores increased from 44% to 50%. Conclusion: AHMC’s EDsʼ significant improvement demonstrated the strong potential of replicating their efforts on improving patient experience and quality measures to other departments and community hospitals.
Authors and Affiliations
Tina T. Tsai
Keywords
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- EP ID EP548227
- DOI 10.17140/EMOJ-2-129
- Views 161
- Downloads 0
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