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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.
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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| to reduce ED length of stay | to reduce ED length of stay to lessen ED crowding by using Lean-sigma management and quality improvement interventions including reducing boarding time and medical decision time. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Quality improvement (QI) interventions | Behavioral | 1. The ED admissions exhibited prolonged length of stay. 2. The Interventions for Reducing Medical Decision Time:
3. The Interventions for Reducing Boarding Time
|
| Measure | Description | Time Frame |
|---|---|---|
| length of stay for ED admissions. | Length of stay was defined as the time from patient registration to leaving the ED. | 12 months |
| Measure | Description | Time Frame |
|---|---|---|
| boarding time for ED admissions | Boarding time was defined as the time from decision for admission to leaving the ED. | 12months |
| decision time for ED admissions | Decision time was defined as the time from patient registration to decision for disposition. |
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Inclusion Criteria:
Exclusion Criteria:
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The patients were registered in the ED of the Hsin-Chu branch from Jan, 2015 to Dec, 2015.
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| ID | Term |
|---|---|
| D058996 | Quality Improvement |
| D008722 | Methods |
| ID | Term |
|---|---|
| D004738 | Engineering |
| D013676 | Technology, Industry, and Agriculture |
| D011787 | Quality of Health Care |
| D006298 | Health Services Administration |
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|
| 12 months |
| the percentage of LOS over 24 hours in all ED patients. | The percentage was defined as patients staying at the ED over 24 hours/total ED visits. | 12 months |
| D008919 | Investigative Techniques |