Page 114 - Lean six sigma demystified

Chapter 3 a Fa S ter Ho S pita L in Five D ay S 93

Staffing for Speed

Most ERs of this size, at peak demand, have

• One triage nurse to evaluate walk-in patients by level of acuity with an
average of 6 minutes per patient.
• One or two registrars to handle insurance and hospital paperwork: 6 to
12 minutes per patient.
• Two MDs (one off peak): 12 minutes per patient (some less, some more
on the basis of acuity). One trauma patient can completely consume one
or both MDs.
• One lab technician to collect blood samples (60% of patients require lab
work: 10 minutes per patient).
• One nurse for every two patients (sometimes with 1:1 nursing for trau-
mas): 12 minutes per patient alternating.
Lab work often takes 45 to 60 minutes start to finish (but only 11 minutes
of value-added time, the rest is travel and delay). A third of all patients will also
need some sort of medical imaging (X-ray, CT scan, MRI, and so forth) which
also takes 45 to 60 minutes (most of it travel and wait time).

Transfer Time

Estimate that 25% of ER patients will be converted to inpatients. That means
30 per day or 5 per unit. Traumas go to ICU. Chest pain patients go to telem-
etry. The rest go to medical or surgical beds.
How long does it take to move an admitted patient to an inpatient bed? It

shouldn’t take any longer than 30 minutes although most hospitals run longer
than this. Why? Trying to sync up the ER and floor nurse to give a report on the
patient’s condition and diagnosis.
Solution: Fax or voice mail the report and transport the patient to the floor
as soon as a bed is ready.

Faster Door-to-Balloon (D2B) Time in Five Days

In 2004, The ED at UMass Memorial Health Care reduced D2B from
180 minutes to less than 60 minutes. To optimize D2B times, they measured and
optimized the four key steps: (1) door-to-EKG completion, (2) data to diagnosis,
(3) diagnosis to decision, and (4) decision to balloon. Door-to-EKG time fell to