Redesigning emergency department patient flows: application of Lean thinking to health care
Abstract
Objective: To describe in some detail the methods used and outcome of an application of concepts from Lean Thinking in establishing streams for patient flows in a teaching general hospital ED. Methods: Detailed understanding was gained through process mapping with staff followed by the identification of value streams (those patients likely to be discharged from the ED, those who were likely to be admitted) and the implementation of a process of seeing those patients that minimized complex queuing in the ED. Results: Streaming had a significant impact on waiting times and total durations of stay in the ED. There was a general flattening of the waiting time across all groups. A slight increase in wait for Triage categories 2 and 3 patients was offset by reductions in wait for Triage category 4 patients. All groups of patients spent significantly less overall time in the department and the average number of patients in the ED at any time decreased. There was a significant reduction in number of patients who do not wait and a slight decrease in access block. Conclusions: The streaming of patients into groups of patients cared for by a specific team of doctors and nurses, and the minimizing of complex queues in this ED by altering the practices in relation to the function of the Australasian Triage Scale improved patient flow, thereby decreasing potential for overcrowding.
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Lean implementation in reviewed emergency departments was associated with decreased proportion of patients leaving the emergency department without being seen.
“Decreased proportion of patients leaving ED without being seen [ 72 ] [ 75 ] [ 76 ] [ 77 ] [ 81 ] [ 83 ]”
From Lean Thinking in Emergency Departments: A Critical Review (2011) · cites this paper as [72]
Lean implementation in reviewed emergency departments was associated with decreased emergency department length of stay.
“Decreased ED length of stay [ 72 ] [ 73 ] [ 75 ] [ 76 ] [ 79 ] [ 80 ] [ 81 ] [ 83 ] [ 85 ]”
From Lean Thinking in Emergency Departments: A Critical Review (2011) · cites this paper as [72]
Lean implementation in reviewed emergency departments was associated with decreased waiting time to be seen.
“Decreased waiting time to be seen [ 72 ] [ 77 ] [ 79 ] [ 80 ] [ 81 ]”
From Lean Thinking in Emergency Departments: A Critical Review (2011) · cites this paper as [72]
In one reviewed study, there was no change in waiting time to see physician.
“No change in waiting time to see physician [ 72 ]”
From Lean Thinking in Emergency Departments: A Critical Review (2011) · cites this paper as [72]
In one reviewed study, there was decreased compliance with national waiting time recommendations for higher-acuity patients.
“Decreased compliance with national waiting time recommendations for higher-acuity patients [ 72 ]”
From Lean Thinking in Emergency Departments: A Critical Review (2011) · cites this paper as [72]
Some reviewed studies reported that employees became empowered to suggest future changes.
“some studies indeed reported that their employees became empowered to suggest future changes [72] and to control the design of their own work [75]”
From Lean Thinking in Emergency Departments: A Critical Review (2011) · cites this paper as [72]
In one reviewed study, there was no change in perceived patient safety or mortality rate.
“No change in perceived patient safety or mortality rate [ 72 ]”
From Lean Thinking in Emergency Departments: A Critical Review (2011) · cites this paper as [72]
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- Authors
- King, D. L., Ben‐Tovim, D. I., & Bassham, J.
- Affiliations
- Flinders Medical Centre (AU)
- Corresponding author
- King, Diane L
- ORCID
- Bassham, Jane
- Venue
- Emergency Medicine Australasia
- Publisher
- Wiley
- Published
- 2006-06-29
- Volume
- 18
- Issue
- 4
- Pages
- 391-397
- ISSN
- 1035-6851 (ISSN-L)
- 1742-6731
- 1742-6723
- OpenAlex
- W2132377426
- Cited by
- 279
- References
- 14
- Citations by year
- 2026: 3 · 2025: 7 · 2024: 2 · 2023: 3 · 2022: 8 · 2021: 19 · 2020: 11 · 2019: 13 · 2018: 12 · 2017: 21 · 2016: 11 · 2015: 24 · 2014: 31 · 2013: 20 · 2012: 22
- FWCI
- 9.81
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Emergency Medicine Australasia (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
- Health Sciences › Health Professions › Emergency Medical Services › Healthcare Operations and Scheduling Optimization
- Health Sciences › Health Professions › Health Information Management › Healthcare Quality and Management
- Keywords
- emergency department patient flow, lean thinking, process mapping, value stream, waiting time, length of hospital stay, triage, Australasian Triage Scale, access block, emergency department overcrowding, queueing
- MeSH terms
- Emergency Service, Hospital, Hospital Administration, Humans, Length of Stay, Outcome and Process Assessment, Health Care, Quality Assurance, Health Care, South Australia, Time Factors, Triage, Waiting Lists, Models, Organizational
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