Page 116 - Lean six sigma demystified

Chapter 3 a Fa S ter Ho S pita L in Five D ay S 95

7. Initiating admission kicks off a pull signal for a bed in the appropriate unit.
If there isn’t enough staff in that unit to handle the admission, a pull signal
may request an on-call nurse to come to work.
8. Instead of all work being done manually, as most of this is now, it’s all
carefully orchestrated and technically linked to minimize all delay. Many
of these activities can happen in parallel, not sequentially as they do
today.

A discharged patient is in and out in 30 minutes. An admitted patient is in a
nursing unit bed in 60 minutes. Of course there will be exceptions, a rush hour
accident may tie up one of the doctors, but most patients are discharged. Find-
ing ways to handle them in one-piece flow will dramatically improve ED
performance.
Using Lean, Providence Health and Services reduced turnaround times in
five hospitals ED; this has cut the ambulance diversion rates from 26% to 3%.
Every ambulance is worth $7000 or more to a hospital’s bottom line. Slashing
diversion rates will boost the bottom line and improve outcomes because if
your hospital’s ED is closer, the patient has a better chance of survival than if
he or she has to commute to a distant hospital for care.
Using Lean, St. Vincent Indianapolis Hospital cut the number of steps ED
nurses take to get the supplies by 78%.
How could Lean help your ED provide faster, better care to more patients?

A Faster Operating Room (OR) in Five Days

Hospital operating rooms don’t operate with anywhere near the efficiency of
Gray’s Anatomy on television. Surgeries run long. Some are cancelled. Some
surgeons are faster than others. Elective surgeries sometimes block emergency
surgeries. Every hospital wrestles with these problems.
Copenhagen University Hospital wanted to reduce the time between surgical
operations. The improvement team found that too much time (60+ minutes)
was spent

• Investigating if the patient got required information from the surgeon
(10 minutes)

• Unpacking individual sterile disposables (30 minutes)
• Waiting for missing devices (5 trips per surgery)