Triage patient flow redesign in an urban academic emergency department

Abstract

<p><strong>Purpose:</strong> The purpose of this process improvement project is to evaluate whether the implementation of &ldquo;Lean approach&rdquo; interventions in the triage redesign of an urban academic emergency department improves outcome measures (ED metrics: Left without Being Seen (LWBS), length of stay (LOS), patient satisfaction) and patient experience. This project aims to provide insights on the process improvement interventions implemented to address issues of increased length of stay, increased LWBS and decreased patient satisfaction scores after opening of a new 60 bed ED in an urban academic medical center in January 2012.</p> <p><strong>Design:</strong> This evidence based project is a quality improvement process redesign of the triage patient flow using the &ldquo;Lean process approach&rdquo; process improvement methodology. Setting: The study site is a 60 bed urban comprehensive academic ED in Chicago serving an average of 65,000 patients a year. Participants/Subjects: The study population consists of all emergency department (ED) patients&rsquo; visits to the ED from January 2012 to December 2013. Methods:</p> <p><strong>Methods:</strong> De-identified data from electronic medical record (EMR) and administrative and clinical data were accessed. Comparisons were made between the 12 months before (January 2012 to November 2012) and 12 months after (from December 2012 to December 2013) implementation of the changes/processes. The triage redesign and rapid improvement process was implemented utilizing the &ldquo;Lean approach&rdquo; process improvement methodology through process mapping with ED leadership and staff of ED throughput by identifying patients likely to be discharged from the ED and those likely to be admitted. Data were also obtained from Press Ganey Scores in relation to patient satisfaction.</p> <p><strong>Results/Outcomes:</strong> Following process mapping by staff and ED leadership using &ldquo;Lean approach&rdquo; methodology, patient flow in triage pod was restructured concentrating on patients likely to be discharged (those with Emergency Severity Index (ESI) level 4 and 5). Interventions implemented by streaming and directing patients to different care areas in the ED have shown improvement in LWBS and length of stay of patients predicted to be discharged. Average length of stay of patients&rsquo; awaiting inpatient beds stayed similarly the same. Patient experience as shown in Press Ganey Patient Satisfaction score improved slightly.</p> <p><strong>Implications:</strong> The use of &ldquo;Lean approach&rdquo; process improvement methodology offers improvement opportunities in the emergency department and has shown favorable effects especially with streaming of patients into groups by altering practices in relation to the function of Emergency Severity Index triage scale to improve patient flow and throughput. Further studies are recommended in understanding of&rdquo;Lean approach&rdquo; effects in relation to patient safety and quality outcomes and on staff satisfaction.</p>