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Applying the Lean principles of the Toyota Production System to reduce wait times in the emergency department

Published online by Cambridge University Press:  21 May 2015

David Ng ,
Gord Vail ,
Sophia Thomas  and
Nicki Schmidt
David Ng*
Affiliation:
Emergency Department, Hôtel-Dieu Grace Hospital, Windsor, Ont.
Gord Vail
Affiliation:
Emergency Department, Hôtel-Dieu Grace Hospital, Windsor, Ont.
Sophia Thomas
Affiliation:
Emergency Department, Hôtel-Dieu Grace Hospital, Windsor, Ont.
Nicki Schmidt
Affiliation:
Emergency Department, Hôtel-Dieu Grace Hospital, Windsor, Ont.
*
Emergency Department, Hôtel Dieu Grace Hospital, 1030 Ouellette Ave., Windsor ON N9A 1E1; dng@hdgh.org

Abstract

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Objective:

In recognition of patient wait times, and deteriorating patient and staff satisfaction, we set out to improve these measures in our emergency department (ED) without adding any new funding or beds.

Methods:

In 2005 all staff in the ED at Hôtel-Dieu Grace Hospital began a transformation, employing Toyota Lean manufacturing principles to improve ED wait times and quality of care. Lean techniques such as value-stream mapping, just-in-time delivery techniques, workplace organization, reduction of systemic wastes, use of the worker as the source of quality improvement and ongoing refinement of our process steps formed the basis of our project.

Results:

Our ED has achieved major improvements in departmental flow without adding any additional ED or inpatient beds. The mean registration to physician time has decreased from 111 minutes to 78 minutes. The number of patients who left without being seen has decreased from 7.1% to 4.3%. The length of stay (LOS) for discharged patients has decreased from a mean of 3.6 to 2.8 hours, with the largest decrease seen in our patients triaged at levels 4 or 5 using the Canadian Emergency Department Triage and Acuity Scale. We noted an improvement in ED patient satisfaction scores following the implementation of Lean principles.

Conclusion:

Lean manufacturing principles can improve the flow of patients through the ED, resulting in greater patient satisfaction along with reduced time spent by the patient in the ED.

Résumé

RÉSUMÉObjectif:

Compte tenu de la longueur des temps d'attente des patients et de la détérioration du niveau de satisfaction des patients et du personnel, nous avons cherché à améliorer ces mesures dans notre service d'urgence sans financement ou lits additionnels.

Méthodes:

En 2005, l'ensemble du personnel du service d'urgence de l'hôpital Hôtel-Dieu Grace a amorcé une transformation, en appliquant les principes de production « au plus juste » de Toyota pour améliorer les temps d'attente et la qualité des soins. La base de notre projet était fondée sur les techniques au plus juste, comme la cartographie des flux de valeurs, la livraison juste-à-temps, l'organisation du milieu de travail, la réduction des gaspillages systémiques, le recours au travailleur en tant que source d'amélioration de la qualité et l'amélioration constante des étapes de nos processus.

Résultats:

Notre service d'urgence a réalisé d'importantes améliorations en ce qui concerne le déroulement des activités sans avoir ajouté de lits supplémentaires à l'urgence ou dans l'hôpital. La moyenne de temps entre l'inscription et la consultation du médecin a diminué, passant de 111 à 78 minutes. Le nombre de patients quittant l'urgence sans avoir été vus par un médecin est passé de 7,1 à 4,3 %. La durée de séjour pour les patients qui ont obtenu leur congé a diminué, passant d'une moyenne de 3,6 heures à 2,8 heures. La plus forte baisse a été enregistrée chez les patients ayant un niveau de triage 4 ou 5, selon l'échelle canadienne de triage et de gravité pour les services d'urgence. Nous avons observé une amélioration des scores de satisfaction des patients à l'urgence après l'application des principes de production au plus juste.

Conclusion:

Les principes de production au plus juste peuvent améliorer le déplacement des patients à l'urgence, occasionnant une hausse de la satisfaction et une baisse de la durée de séjour des patients à l'urgence.

Keywords

ED administrationLean principleslength of staytime to physicianwait time
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 12 , Issue 1 , January 2010 , pp. 50 - 57
Copyright
Copyright © Canadian Association of Emergency Physicians 2010

References

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