Okay I stole that title from a LEAN Blog. But it got you reading … as part of our new ER design we had to come to terms with our current reality… the data
The Data was one of the NOT NEGOTIABLES – and rightly so.
The logistics folks spent a lot of time watching patients walk through the ER. They repeated this for several patient encounters. They looked at folks who went home and those that got admitted. They also compared this to the data that we already collect and the two samples were mirror images. In short THE DATA IS VALID and … The data also shows that there was lots of room for improvement
Ever heard of the Pareto Principle? On the left we see that [this is adult ER data] 20% of patients that stay 803 minutes [that’s over 13 hours]. This is the ‘lead time’ [on the right] which is the time they spend “in the Fish” [see 3-P day 1] if they are being admitted.
You can see on the right diagram that the ‘cycle time‘ for an admission [which is the actual time that the patient is being worked on] is 740 minutes. That leaves almost 3 hours [163 minutes] of non-value added time. [i.e Waiting]. For patients going home, there is about an hour and a half worth of time that could be shaved off.
Although most of this time is waiting [Waiting to be triaged, waiting to see the doctor, waiting to go for tests, waiting to receive test results.], some of it is going long distances for tests.
Having worked in the ER for 3 years [and having been part of the executive] I can assure that we’re constantly trying to reduce these needless waits. We’ve changed to a parallel triage and registration process. We have more docs on at peak times. We have created “rapid assessment and treatment” areas. We have installed a very expensive computer-tracking system with screens to give us real-time data. We use nurse-initiated protocols at the door so that labs and x-rays can be ordered while you wait. We tinker like golfers always looking for an edge. BUT …
While it seems there is still a little room for improvement, we cannot fix the waiting on our own. We need help from our consultant colleagues to see consults faster, admit patients quicker. We need help from lab and diagnostic imaging to reduce turn-around times for tests. The system needs to support us … While I am optimistic that we’re in for a positive revolution in the way we operate, some of these things we could do tomorrow rather than waiting for a new structure in 2016.