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. 2018 Dec 3;18(1):914.
doi: 10.1186/s12913-018-3654-0.

Lean thinking to improve emergency department throughput at AORN Cardarelli hospital

Giovanni Improta  1 , Maria Romano  2   3 , Maria Vincenza Di Cicco  4 , Anna Ferraro  4 , Anna Borrelli  5 , Ciro Verdoliva  6 , Maria Triassi  4 , Mario Cesarelli  7   3
Affiliations

Lean thinking to improve emergency department throughput at AORN Cardarelli hospital

Giovanni Improta et al. BMC Health Serv Res. .

Abstract

Background: Throughout the world, emergency departments (ED) are characterized by overcrowding and excessive waiting times. Furthermore, the related delays significantly increase patient mortality and make inefficient use of resources to the detriment of the satisfaction of employees and patients. In this work, lean thinking is applied to the ED of Cardarelli Hospital of Naples with the aim of increasing patient flow, improving the processes that contribute to facilitating the flow of patients through the various stages of medical treatment and eliminating all bottlenecks (queue) as well as all activities that generate waste.

Methods: This project was performed at National Hospital A.O.R.N. A. Cardarelli of Naples. The historical times of access to the ED were analysed from January 2015 to June 2015, for a total of 16,563 records. Subsequently, starting in November 2015, corrective actions were implemented according to the Lean Approach. Data collected after the introduced improvements were collected from April 2016 to June 2016 and compared to those collected during the starting period.

Results: The results acquired before application of the Lean Thinking strategy illustrated the as-is process with its drawbacks. An analysis of the non-added value activities was performed to identify the procedures that need to be improved. After implementation of the corrective actions, we observed a positive increase in the performance of the ED, quantified as percentages of hospitalized patients according to triage codes and waiting times.

Conclusion: This work demonstrates the applicability of Lean Thinking to ED processes and its effectiveness in terms of increasing the efficiency of services and reducing waste (waiting times).

Keywords: Emergency department; Lean thinking; Public health; Quality improvement.

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Conflict of interest statement

Ethics approval and consent to participate

The authors declare that, given the nature of the collected and analysed data, no ethic authorizations and no consent declarations were required. The Italian National Health Service (Law N.211 24/06/2003) requires the preliminary ethical approval of research only in cases of clinical trials of investigational medicinal products, medical devices, drug/device combination, and clinical investigation. Our study is solely a service/satisfaction evaluation. Furthermore, Italian law on privacy and data protection (Law N. 196/2003) requires formal actions only in cases of personal and/or sensitive data. Our analysis is completely anonymous, and no personal information was linked or linkable to a specific respondent. Moreover, given the nature of the study, no sensitive data were collected or analysed.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Value Stream Map
Fig. 2
Fig. 2
Balance chart before and after Lean interventions
Fig. 3
Fig. 3
Control charts by colour code
See this image and copyright information in PMC

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