The Journey Toward a Lean ED

Session
Emergency Services

Author
Jody Crane
MD & adjunct professor
The University of Tennessee College of Business

Description
This session will outline advances made in a busy, 100,000 visit Emergency Department at Mary Washington Hospital on a journey toward a complete lean transformation. Original applications of Lean will be presented including Super Track and Rapid Assessment, Triage, and Efficient Disposition in the Emergency Department (R.A.T.E.D. ER). Future directions toward completing the lean journey will be discussed.

Abstract
To date there have been limited applications of Lean within healthcare. There have been an equally limited number of applications in Emergency Department settings with no complete ED lean transformations. This presentation will focus on the transformation of a busy, 100,000-visit Emergency Department into a Lean ED. Two specific projects will be outlined from a process improvement perspective, detailing change management methods, lean tools implemented, and outcomes related to flow and throughput. Where applicable, pitfalls and cultural issues will be detailed. The first project called, Super Track, will focus on lean tools applied in a fast track setting located in triage. Lean Tools such as value stream mapping (current and future state), concurrency, rapid change over, load leveling, standard work, and elimination of waste will be highlighted. This project highlights the benefits of applying lean concepts to low acuity patients resulting in a decrease in length of stay (LOS) from 2.5 hour to less than 1 hour. The project demonstrates a consistent LOS of 35 minutes for ESI triage level 5 patients. Other examples of similar implementations in conjunction with work at the Institute for Healthcare Improvement will be referenced. The second project called, Rapid Assessment, Triage, and Efficient Disposition in the Emergency Department (R.A.T.E.D. ER), will focus on lean tools applied to a value stream of ESI level 3 patients. Lean tools such as rapid improvement teams, takt times, visual signals, load leveling, standard work, and elimination of waste will be demonstrated to markedly improve efficiency. Project highlights a 14% decrease in overall ED LOS, 66% reduction of triage time, 45% reduction in door to doc time, and 24% reduction in In-ED evaluation. Future directions towards a complete lean transformation will be discussed highlighting the impact of variation, and the value of patient value streams, patient segmentation, and application of lean tools.