Improving Patient Flow in Emergency Rooms

Many hospitals are focusing their lean efforts on emergency rooms, trying to streamline the flow of patients through that increasingly busy department.

(I know I’ve been writing a lot about healthcare lately, but that’s where some of the most interesting lean developments are taking place.)

An interesting recent article in The New York Times describes some of the changes taking place in ERs. The article, written by Sarah Kershaw, doesn’t actually focus on process improvement. However, it offers some tantalizing hints that lean may be part of what is taking place.

The article focuses on urban hospitals in New York. However, Kershaw notes a variety of factors that are fueling ongoing growth in the numbers of people who come to emergency rooms throughout the nation. These include growing numbers of uninsured patients, rapid population growth in urban areas where hospitals are located, a shortage of primary care doctors, and the closing of bankrupt hospitals, which increases demand at those that survive.

One result is that many hospitals – if they can find the funding – are expanding their emergency rooms, or adding additional ERs.

And part of the article focuses on the changing nature of the ER to make patients more welcome and comfortable. These efforts range from the addition of individual flat-screen televisions and telephones to the addition of child-care specialist who work with children.

However, any attempt to address ER overcrowding must include a focus on improving patient flow. The article describes some of these efforts:

At St. Vincent’s Hospital Manhattan, officials recently spent $7.6 million to create what they call a “fast-track” option to speed the treatment of patients with more minor injuries. St. Luke’s-Roosevelt Hospital Center recently embarked on a $15 million project to double its capacity at the Roosevelt campus…

Some hospitals now have “navigators,” staff members assigned solely to the uninsured to handle the cumbersome paperwork required for registering them. And an increasing number have also instituted the fast-track systems, which Beth Israel Medical Center in Manhattan — now constructing an emergency room that will be twice the size of its current one — is calling “fast-food McDonald’s-type in-and-out service.”

The fast-track systems divide emergency rooms into areas for patients with minor injuries for those with more acute problems, so that someone with a sprained ankle is not lumped together with a patient who is bleeding profusely from the head.

Sorting patients by the severity of injury is a lean approach – think of it as dividing products into families, based on what is needed to complete their production.

Of course, once these categories are established, a hospital needs to go a step further. It needs to focus on the processes by which each group of patients is received and brought through the emergency room. The article does not indicate whether the hospitals mentioned above are taking that step.

However, I suspect and hope at least some of them are. That way, if you or I need to visit an emergency room, we will experience improved service.


Dean Bliss said...

Great article, Ralph. The issues with ED patient flow are quite complex - they include turnaround time for tests, time to admit patients to the inpatient units, and beyond, making the issue one not only in the ED, but in the entire hospital. Opportunities abound for improvement, and many of us are doing our best to address them.

Ian Furst said...

Another good article -- ERs have special circumstances but when we doubled the size of our clinic the presumption was additional space would diminish wait times. It actually added complexity and people waited longer. It wasn't until we did a process flow map that we realized moving the reception away from the consultation area had had a profound impact on the patients. Again, only data is going to show the true picture. www.waittimes.blogspot.com

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