Dissecting delays in trauma care using corporate Lean Six Sigma methodology
Abstract
OBJECTIVE: The Institute of Medicine has identified trauma center overcrowding as a crisis. We applied corporate Lean Six Sigma methodology to reduce overcrowding by quantifying patient dwell times in trauma resuscitation units (TRU) and to identify opportunities for reducing them. METHODS: TRU dwell time of all patients treated at a Level I trauma center were measured prospectively during a 3-month period (n = 1,184). Delays were defined as TRU dwell time >6 hours. Using personnel trained in corporate Lean Six Sigma methodology, we created a detailed process map of patient flow through our TRU and measured time spent at each step prospectively during a 24/7 week-long time study (n = 43). Patients with TRU dwell time below the median (3 hours) were compared with those with longer dwell times to identify opportunities for improvement. RESULTS: TRU delays occurred in 183 of 1,184 trauma patients (15%), and peaked on days with >15 patients or with presence of five simultaneous patients. However, 135 delays (74%) occurred on days when </=15 patients were treated. Six Sigma mapping identified four processes that were related to TRU delays. Reduction of TRU dwell time by 1 hour per patient using interventions targeting these specific processes has the potential to improve our TRU capacity to care for more patients. CONCLUSION: Application of corporate Lean Six Sigma methodology identified opportunities for reducing dwell times in our TRU. Such endeavors are vital to maximize operational efficiency and decrease overcrowding in busy trauma centers working at capacity.
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Three studies combined Lean with Six Sigma, and another also borrowed from many other manufacturing philosophies.
“Three studies [69, 82, 83] combined Lean with Six Sigma, a quality improvement method based on minimizing variability, while another also “borrowed from many other manufacturing philosophies” [71].”
From Lean Thinking in Emergency Departments: A Critical Review (2011) · cites this paper as [82]
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Lean Thinking in Emergency Departments: A Critical Review
Holden, R. J. (2011) · Annals of Emergency Medicine · doi:10.1016/j.annemergmed.2010.08.001 · Cited by 516 · see citing works
- Authors
- Parks, J. K., Klein, J., Frankel, H. L., Friese, R. S., & Shafi, S.
- Affiliations
- Parkland Memorial Hospital (US)
- Venue
- Journal of Trauma: Injury, Infection & Critical Care
- Published
- 2008-11
- Volume
- 65
- Issue
- 5
- Pages
- 1098-1105
- ISSN
- 0022-5282 (ISSN-L)
- OpenAlex
- W2072220490
- Cited by
- 43
- References
- 11
- Citations by year
- 2026: 1 · 2023: 1 · 2022: 1 · 2020: 2 · 2019: 1 · 2018: 5 · 2017: 3 · 2016: 5 · 2015: 7 · 2014: 7 · 2013: 4 · 2012: 1
- FWCI
- 2.63
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Trauma: Injury, Infection, and Critical Care (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Health Professions › Emergency Medical Services › Healthcare Operations and Scheduling Optimization
- Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
- Health Sciences › Medicine › Emergency Medicine › Trauma and Emergency Care Studies
- Keywords
- process delays, Lean Six Sigma, process mapping, time study, patient flow, operational efficiency
- MeSH terms
- Emergency Service, Hospital, Patient Care, Humans, Length of Stay, Outcome and Process Assessment, Health Care, Time Factors, Trauma Centers, Urban Population, Wounds and Injuries, Process Assessment, Health Care, Efficiency, Organizational, Total Quality Management
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