Use of Lean Six Sigma Methodology for Improving the Patient

Throughput at Holtz Children’s Hospital Emergency Department

PURPOSE

To decrease the overall Length of Stay (LOS) for patients treated at the Holtz Children’s Hospital Emergency Department (ED)

BACKGROUND/SIGNIFICANCE

Long wait times for patients treated in the ED can impact patient’s experience and satisfaction. Although the Holtz Children’s Hospital has historically reported satisfactory throughput times, monthly metrics reported for Door to Triage, Door to Doctor, Doctor to Disposition, Disposition to Discharge, Left Without Being Seen, and overall LOS revealed areas for improvement. A Process Improvement project team was put in place to address the identified areas of improvement. The overall goal of the team was to decrease the average LOS of ED patients as established by pre-determined quarterly goals and thereby improve patient & staff satisfaction.

METHOD

Six Sigma DMAIC methodology and Lean tools were used to address operational inefficiencies in patient throughput in the ED. A cross-functional project team including physicians, nurses, administrators, and financial personnel was formed in May 2016. The team agreed to begin by addressing the front-end areas (Fast-Track) of the ED and focus later on the back-end areas (Patient Admissions). Patient flow was mapped and opportunities for removing “waste in the process” were identified. After conducting and validating the Root Causes of the sub-optimal throughput times, the team brainstormed solutions and created an implementation plan. The team decided to track project success with the following metrics: average LOS of Acuity Level 1-3 and average LOS Level 4-5 patients in the ED before and after implementation of the changes.

RESULTS

Using Lean Six Sigma tools, improvement strategies to improve patient flow in the Holtz ED were developed, including redesigning the layout of the Fast-Track area, matching staffing schedules to patient volumes, implementation of bed-side registration, and computer terminals installed in every exam room to allow for timely documentation. Opportunities to reduce waste in the patient flow were also identified such as consolidation of supplies stored in Omnicells resulting in an extra exam room to and less charges for Omnicell usage. Additionally, provider motion was decreased by placing an Omnicell closer to the Fast-track exam rooms. The baseline (January through July 2016) average LOS of Acuity Level 1-3 and average LOS Level 4-5 patients were 264+161 minutes and 178+125 minutes, respectively. The team will begin to report the new LOS once changes in staff schedules and space lay-out are implemented.

CONCLUSION

The ED is a key location where positive or negative perceptions of the hospital can be formed. Thus, efficient operations in the ED can help improve patient and staff satisfaction. Lean Six Sigma tools can be applied successfully to an ED setting and allow teams to incorporate their ideas to improve processes. Using these tools, the Holtz ED Process Improvement project team identified creative ways to address operational inefficiencies and to eliminate waste in their processes. The project’s success will ultimately be determined by improvement in the LOS metrics.

Vanessa A. Plunkett, RN, MSN-HCA; Maria C. Jimenez, PhD, MS, MBA

Holtz Pediatric Emergency Department