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. 2011 May;12(2):184-91.

Applying lean: implementation of a rapid triage and treatment system

Karen L Murrell  1 , Steven R Offerman, Mark B Kauffman
Affiliations

Applying lean: implementation of a rapid triage and treatment system

Karen L Murrell et al. West J Emerg Med. 2011 May.

Abstract

Objective: Emergency department (ED) crowding creates issues with patient satisfaction, long wait times and leaving the ED without being seen by a doctor (LWBS). Our objective was to evaluate how applying Lean principles to develop a Rapid Triage and Treatment (RTT) system affected ED metrics in our community hospital.

Methods: Using Lean principles, we made ED process improvements that led to the RTT system. Using this system, patients undergo a rapid triage with low-acuity patients seen and treated by a physician in the triage area. No changes in staffing, physical space or hospital resources occurred during the study period. We then performed a retrospective, observational study comparing hospital electronic medical record data six months before and six months after implementation of the RTT system.

Results: ED census was 30,981 in the six months prior to RTT and 33,926 after. Ambulance arrivals, ED patient acuity and hospital admission rates were unchanged throughout the study periods. Mean ED length of stay was longer in the period before RTT (4.2 hours, 95% confidence interval [CI] = 4.2-4.3; standard deviation [SD] = 3.9) than after (3.6 hours, 95% CI = 3.6-3.7; SD = 3.7). Mean ED arrival to physician start time was 62.2 minutes (95% CI = 61.5-63.0; SD = 58.9) prior to RTT and 41.9 minutes (95% CI = 41.5-42.4; SD = 30.9) after. The LWBS rate for the six months prior to RTT was 4.5% (95% CI = 3.1-5.5) and 1.5% (95% CI = 0.6-1.8) after RTT initiation.

Conclusion: Our experience shows that changes in ED processes using Lean thinking and available resources can improve efficiency. In this community hospital ED, use of an RTT system decreased patient wait times and LWBS rates.

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Figures

Figure 1.
Figure 1.
Lean principles.
Figure 2.
Figure 2.
Value-stream map of the triage process prior to Lean process changes. C/T, cycle time; C/O, changeover time; WR, waiting room; IT, information technology
Figure 3.
Figure 3.
Value-stream map of the triage process after Lean process changes. RTT, rapid triage and treatment, ED, emergency department; C/T, cycle time; C/O, changeover time.
Figure 4.
Figure 4.
Emergency department (ED) census and left without being seen (LWBS) rates. Gray bars denote monthly ED census (left axis) and black bars denote LWBS rates (right axis).
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