Page 115 - Lean six sigma demystified

94 Lean Six Sigma DemystifieD

1 to 2 minutes; this enabled the ED physician to stay in the room to diagnose,
decide, and call in the surgical team. On-call teams were scheduled with at least
one team member within 20 minutes of the hospital. Valet parking of team cars
cut 5 minutes off the time. Electronic EKG transmission from ambulances to
the ED removed additional delays allowing patients to go directly to the cardiac
catheterization lab bypassing the ED and reducing D2B times to less than 50
minutes. These changes reduced AMI mortality to 11.7 percent, significantly
below the 16.6 percent national average.
Lessons learned from D2B times were applied to door-to-incision time for
vascular surgery and door-to-diuretic times for congestive heart failure
patients.

Imagine a Faster ED

Imagine an emergency room where patients walk in and something surprising
happens.

1. They use the magnetic strip on the driver’s license, insurance card, or
credit card to check in and register using a kiosk. The kiosk automatically
takes pictures of all of these IDs and uses the data to find the patient’s
medical history, validate insurance, and so on.
2. Completing registration this way triggers a pull signal that brings the next
nurse in the rotation to collect the patient from the entry area and move
the patient to an exam room.
3. Entering the exam room and gathering the patient’s vital signs triggers a
pull signal for the next ED doctor in the rotation.

4. The doctor examines the patient with the nurse available and requests any
tests or X-rays using a handheld device that kicks off the orders.
a. The nurse draws any blood or other samples required and either sends
them to the lab for processing or uses point-of-care testing to get results
in 11 minutes or less.
b. The nurse transports the patient to imaging if needed.
5. Completion of the tests triggers a pull signal to the ED doctor to collect
the results, diagnose, and recommend treatment.
6. The doctor then initiates treatment. Any teaching material or paperwork
is prepackaged and ready for the nurse to prepare the patient for discharge
or admission.