Objective: In recognition of patient wait times, and deteriorat- ing 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 Hospi- tal began a transformation, employing Toyota Lean manufac- turing 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 sys- temic 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 depart- mental 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 Cana- dian Emergency Department Triage and Acuity Scale. We noted an improvement in ED patient satisfaction scores fol- lowing 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.
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