Question

Set-up:                                                                                                                                               

You are the executive team for a 350-bed hospital in a mid-size city (250,000 residents) in the United States.                                                                                                                              Problem:                                                                                                                                           

Your hospital is weighing options to reduce overcrowding in the Emergency Department. In the past 6 months, you have had 3 physicians resign or come close to resigning because of their disgust with the operations of the ER. They claim it is inefficient and that patients are suffering because of lack of timely access to exams, tests, etc. In addition, a website has just sprung up in your area that tracks the average wait time of local hospital ERs. The average wait time (i.e. time before the patient sees a physician) at your hospital ER is nearly 2 hours (more than double that of your competitor), and the average total visit time is almost 7 hours! As an executive team, you worry that loss in ER visits from this negative publicity will have a downstream negative impact on total inpatient utilization.        

Background Information:                                                                                                   

Your hospital contracts with an emergency medicine physician group to staff your ED (i.e. these are not employed physicians). The physician practice is NOT profitable and requires your hospital to subsidize it financially. Currently, you staff the ED according to a matrix that averages daily volume over the past year and schedules enough staff resources to care for that volume. You have 17 patient rooms in your ED, and you utilize shared MRI/CT/lab facilities with the inpatient nursing units. Typical volume in the ED ranges from around 130 visits (on a very slow day) to more than 300 visits on a very busy day. These visits are triaged and seen using an industry-standard assessment plan.                                                                                                          

Your patient satisfaction scores in the ED are consistently low, with "waiting" and "provider communication" being the most common complaints. Your ED is NOT currently a trauma center, but some of the emergency physicians that you contract with have expressed interest in obtaining that designation.

Choices:                                                                                                                                                                     

Your hospital can choose to:                                                                                                 

A) Do nothing - ED's are inefficient by their nature and thre is very little that we can do about it.   

B) Start a kaizen event to identify inefficiencies in the ED (where do you think you might find some opportunities?)                                                     

C) Terminate your contract with the Emergency Medicine physician group and hire your own emergency medicine physicians.            

D) Close your ED entirely and rely on scheduled admissions and transfers to keep your hospital beds full.                                                                                                                                  

E) Build a freestanding emergency department at an offsite location to provide additional capacity and free up your current ED.          

F) Other Strategy:                                                                                                                                          

Justification:                                                                                                                         

Please justify your choice above - what were your reasons for choosing and what do you anticipate will happen as a result of your choice?                                                                                                                                          

                                                                                                                                                                                                           

                       

Answer 1

Background Information

1. At present, the hospital contracts with an emergency medicine doctor group to staff your ED [i.e. these are not utilized, physicians].

2. The doctor practice isn't gainful and requires the hospital to finance it monetarily.

3. The ED as indicated by a grid that midpoints day by day volume over the previous year and schedules enough staff assets to think about that volume.

4. The patient fulfillment scores in the ED are reliably low, with pausing and supplier correspondence being the most well-known grievances.

5. The ED isn't presently an injury focus, however, a portion of the emergency doctors that the hospital contract with has communicated enthusiasm for getting that designation.

The hospital can choose to -

Start a kaizen event to identify inefficiencies in the ED [where do you think you might find some opportunities?]                                                    

[A] The reason for choosing Kaizen event

1. To convey a speedy assessment of the present condition of the emergency department and make arrangements, the hospital can chose to apply Lean ideas.

2. A Kaizen is a guided exertion that applies Lean standards to evaluate a worth stream, recognize wellsprings of expense and waste, and lessen those sources, all inside a brief timeframe outline. The hospital and its groups can start with an assessment of ED forms, including improvement from this assessment, the significant opportunities zones for development were distinguished as:

[1] General design of rooms in the emergency department not supporting the simplicity of patient consideration.

[2] Different collaborations and hold up related to coordinating transportation.

[3] Constrained accentuation on verifying an inpatient bed prompting long hold up times.

[4] With the opportunities zones distinguished and settled upon, the group can prepare to move onto the Kaizen improvement stage. The improvement stage can be arranged in the three-or four-day occasion where key procedure proprietors can be united under the direction of a Lean expert, where improvement zones can be composed and doled out, and hospital groups can progress in the direction of actualizing solutions.

[B] The result of the choice

The key separation between a Kaizen and other improvement methodologies is that solutions are really field tried and assessed during the Kaizen occasion. This permits the hospital groups and procedure proprietors to quickly assess the viability of the solutions and change as required. The results of this escalated effort are settled upon methodologies completely executed and acknowledged by the procedure proprietors. For the situation where huge speculation or expanded usage times are required, the hospital group builds up a subsequent plan and moves proprietorship to the project sponsor.

1. Concentrating on Bed Management

Tending to bed management, the hospital group can manufacture a system and desires around the bed task process, just as improving the correspondence between the ED staff and bed management. This essentially included utilizing the current ED data framework and the viewable signals that were accessible yet not comprehended or followed upon. With instruction, cheat sheets and obviously imparted desires, bed management is speeding up required coordination to move care-total patients to inpatient beds.

Operation	Problem	Actions Taken	Results
Communication: ED and Bed Management	1. Patients are holding up to withdraw the ED after consideration is finished. 2. No standard procedure or targets. 3. Lack of comprehension of images on the dashboard	1. Put set up standard working systems. 2. Orient staff on key dashboard images	There can be a 71 percent decrease of time from consideration complete to persistent take-off from the ED

The enhancements and advantages for the ED Kaizen were assessed as:

1. Institutionalizing formats and stocking test rooms brought about the disposal of excursions to focal inventory and expanded medical attendant accessibility of each week.

2. Utilizing the current ED data framework brought about a quickened coordination of inpatient beds, or a 71 percent decrease of process duration.