Page 113 - Lean six sigma demystified

92 Lean Six Sigma DemystifieD

9 minutes. So why does it take most EDs over 2 hours to handle each patient?
Sure, some patients need lab work (11 minutes) and others need radiology, but
most of those tests take less than an hour. We’re still looking at 35 to 60 min-
utes, not 2 hours or more.
If we look at admitted patients, they are taken (by ambulance or waiting
room) into the ED immediately without having to wait. They see the doctor
immediately. Tests are done STAT. Registrations are done at the bedside. Nurs-
ing floor bed assignments take only a few minutes. Nursing reports are fast.
Transport to the ICU, cardiac care, or medical/surgical floors take only 15 to
20 minutes. These patients should fly through the ED, but they take longer
than the discharged patients, two to three times longer. Sure they have to be
stabilized, but why does it take hours to get them into an assigned bed?
The answer, across the board, is delay. There is too much time between clini-
cal activities. The admission staff is busy, so patients have to wait. The triage
nurse is busy, so patients have to wait. For those readers familiar with the
Theory of Constraints (TOC), the triage nurse is a bottleneck. The ED boards
patients who should be in a nursing unit, so patients have to wait. The ED nurse
can’t reach the floor nurse to give a report and vice versa. Neither nurse can
leave to transport the patient. Beds are available but not staffed. And so on.
Lean thinking focuses on a key metric called takt time. Takt means “rhythm.”
For the sake of simple analysis, let’s say that the ER handles 120 patients per
day. That would equate to five per hour or one every 12 minutes.
Unfortunately, patients don’t arrive in a rhythmic fashion; they arrive in
waves. The biggest wave is between 3 PM and 9 PM due to rush hour traffic
accidents, parents picking up sick kids from daycare, and so on. The smallest
wave is usually 3 AM to 9 AM. So let’s say patients arrive two to three per hour

at off-peak times and ten per hour at peak times.
That’s one every 6 minutes at peak times.
? still struggling

Follow a patient or two through the eD from the time they arrive until they are
discharged or admitted. you’ll quickly discover that the patient sits and waits for
most of the time they are in the eD. they wait in waiting rooms. they wait in
exam rooms. these delays are unnecessary. eliminate them.