Page 112 - Lean six sigma demystified

Chapter 3 a Fa S ter Ho S pita L in Five D ay S 91

• Bed management delays (assigning beds to admitted patients)
• Late discharges (getting patients out of beds when they are discharged)

• Long patient length of stay (LOS) due to mistakes, errors, falls, and so on
• Lost revenue (all of these problems guzzle cash)

What one element is critical to both patient flow and satisfaction?
Time—wait time and turnaround time.

A Faster Emergency Department (ED) in Five Days

Between 1996 and 2006, ED visits increased from 90 million to 119 million,
but the number of EDs decreased from 4019 to 3833. The increase in patients
and decrease in providers has resulted in overcrowding, boarding, wait times,
and LWOBS (leaving without being seen), all of which lead to poorer outcomes
and patient dissatisfaction.
In 2009, Press Ganey found that ED turnaround times still average over
4 hours, basically unchanged over the last decade. In stark contrast, Robert
Wood Johnson Hospital, winner of the 2005 Baldridge Award, has ED turn-
around times of

• 38 minutes for discharged patients (three-quarters of all ED patients)
• 90 minutes for admitted patients, not 4 hours

How is this possible? How did they do it? They systematically eliminated the
delays between registration, triage, exam, lab, imaging, and discharge or admission/
transport. Because of reduced turnaround times, they offer a 15-minute door-

to-nurse and a 30-minute door-to-doctor guarantees. Faster turnaround times
enabled the hospital to grow by over 10% per year requiring the addition of a
new nursing wing.

HINt Faster patient flow means greater patient satisfaction, better outcomes
and more money!

Patient Satisfaction in the ED. Studies have shown that patient satisfaction
begins to decrease when ED LOS exceeds 2 hours. There are two populations
of patients who visit the ED, so let’s first look at patients who get discharged.
If it only takes a couple of minutes to see the triage nurse, get registered, be
examined by a doctor, then the total time spent on any one patient is perhaps