Moving Patients Out of the Emergency Department: A Lean Project

Session
Quality

Authors
Rachna Priya Khatri
Senior Operations Improvement Analyst
The Methodist Hospital

Johnie Leonard
Director, Emergency Department
The Methodist Hospital

Description
The emergency department is often the entry point for a majority of hospital admissions. This presentation describes one hospital's efforts to improve ED patient flow. This Lean project, which involved rigorous data analysis and collaboration among leadership and staff, enhanced interdisciplinary teamwork, staff and patient satisfaction, and patient flow.

Abstract
The emergency department (ED) is often the entry point for a majority of hospital admissions. The Methodist Hospital, Houston, Texas, treats more than 40,000 patients annually and admits about 43% of those patients. Located in a state with the highest number of uninsured at a time of rising unemployment, the Methodist Hospital faces increased pressure to improve patient flow.

Charged with a mission to decrease the length of stay for ED patients admitted to the main hospital, this Lean project team required rigorous data analysis and collaboration among leadership and staff. Best practices research, process mapping, Dr. Edward DeBono's Lateral Thinking, and Rapid Improvement Events were just a few of the tools utilized to improve processes not only in the ED, but also in Bed Management, Patient Access Services, Patient Transport, and Information Technology.

The project resulted in a 40% reduction in the time to enter a bed request after a physician has decided to admit a patient and a 10% decrease in the time to transfer a patient to an inpatient unit after a bed has been assigned. The team also designed a split flow process to expedite flow by separating patients by acuity upon check-in to the ED.