Length of Stay
Conditions
Brief summary
Emergency department (ED) crowding has become an international challenge in the recent decades. Length of stay (LOS) is a useful marker to monitor ED crowding. Searching for the possible causes and reducing barriers may have the greatest impact on EDLOS. Therefore, the investigators assembled a multidisciplinary team for improvement of the ED process, to undergo assessments of ED patient flow with the spirit of lean-sigma methodologies. The objectives of this study were to evaluate a Lean-sigma-based initiative to lessen EDLOS.
Detailed description
Lean aims to smooth out the workflow and to eliminate wastes. In the ED settings, lean principles can display the process of the ED patient flow. Six sigma, a complementary strategy, has the merit to compensate the potential weakness of Lean through a data-driven process. Currently, a combination of Lean and Six sigma methodologies develops to solve the problems of workflow. It became clear that concurrent multifaceted interventions were needed to reduce EDLOS. Therefore, the investigators assembled a multidisciplinary quality improvement team for improvement of the ED process, to undergo assessments of ED patient flow with the spirit of lean-sigma methodologies. The objectives of this study were to evaluate a Lean-sigma-based initiative to lessen EDLOS.
Interventions
BEHAVIORALQuality improvement (QI) interventions
1\. The ED admissions exhibited prolonged length of stay. 2\. The Interventions for Reducing Medical Decision Time: 1. The ED director created QI education sessions and reported monthly QI outcomes. 2. The ED nurses reported the current number of ED admission patients twice a day to the director. The director summarized the bed requests to the administrative personnel. 3. The nurses reported the in-scene complicated cases to the ED director. The director would give an assistance in managing these cases. 3\. The Interventions for Reducing Boarding Time 1. The ED patients could be admitted before 8 a.m. if the bed was vacant. 2. The ED director initiated an on-line meeting at 8 a.m. and 4 p.m. 3. Monthly QI outcomes were reported in the hospital affairs meeting.
Sponsors
National Taiwan University Hospital Hsin-Chu Branch
Study design
Observational model
CASE_ONLY
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Healthy volunteers
No
Inclusion criteria
* the patients were registered in the ED from Jan, 2015 to Dec, 2015.
Exclusion criteria
* the patients were excluded because of left without seeing a physician.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| length of stay for ED admissions. | 12 months | Length of stay was defined as the time from patient registration to leaving the ED. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| boarding time for ED admissions | 12months | Boarding time was defined as the time from decision for admission to leaving the ED. |
| decision time for ED admissions | 12 months | Decision time was defined as the time from patient registration to decision for disposition. |
| the percentage of LOS over 24 hours in all ED patients. | 12 months | The percentage was defined as patients staying at the ED over 24 hours/total ED visits. |
Outcome results
None listed