Rapid assessment and disposition: applying Lean in the emergency department
Abstract
The nation's emergency rooms are overflowing with patients who endure increasingly long waits to be examined and treated. When our large metropolitan adult acute care hospital adopted LEAN as its standard operating procedure, we began to examine our processes from the customers' perspective and identified a significant opportunity to reduce the emergency department length of stay. Using LEAN tools we designed and implemented a Rapid Assessment and Disposition process to decrease the amount of time patients waited in the emergency department, reduce diversion time, and reduce the number of patients who left without being seen. We have succeeded in reducing the average length of stay for all emergency department patients by 45 minutes, diversion by 55%, and patients who left without being seen by 28%.
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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 [76]
Participating in Lean led frontline staff to participate more in shared governance.
“some studies suggested that Lean may have even brought about a new participative, continuous improvement culture such that participating in Lean led frontline staff to take control of their own work and to participate more in shared governance [76, 78, 83].”
From Lean Thinking in Emergency Departments: A Critical Review (2011) · cites this paper as [76]
Some studies suggested that Lean may have brought about a new participative, continuous improvement culture.
“some studies suggested that Lean may have even brought about a new participative, continuous improvement culture such that participating in Lean led frontline staff to take control of their own work and to participate more in shared governance [76, 78, 83].”
From Lean Thinking in Emergency Departments: A Critical Review (2011) · cites this paper as [76]
Participating in Lean led frontline staff to take control of their own work.
“some studies suggested that Lean may have even brought about a new participative, continuous improvement culture such that participating in Lean led frontline staff to take control of their own work and to participate more in shared governance [76, 78, 83].”
From Lean Thinking in Emergency Departments: A Critical Review (2011) · cites this paper as [76]
Improving employee outcomes was not typically a goal of Lean.
“Improving employee outcomes was not typically a goals of Lean; as one study put it, “the purpose of this LEAN initiative was to improve the care of patients who visited our emergency department” [76].”
From Lean Thinking in Emergency Departments: A Critical Review (2011) · cites this paper as [76]
Cited by
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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
- Eller, A.
- Affiliations
- Baylor St. Luke's Medical Center (US)
- Corresponding author
- Eller, Andrew
- Venue
- Journal for Healthcare Quality
- Published
- 2009-05
- Volume
- 31
- Issue
- 3
- Pages
- 17-22
- ISSN
- 1062-2551 (ISSN-L)
- OpenAlex
- W1975350801
- Cited by
- 42
- References
- 0
- Citations by year
- 2025: 1 · 2023: 1 · 2022: 7 · 2021: 4 · 2020: 3 · 2019: 3 · 2018: 3 · 2017: 2 · 2016: 2 · 2015: 6 · 2014: 3 · 2013: 1 · 2012: 2
- FWCI
- 2.10
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal for Healthcare Quality (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
- lean healthcare, emergency department, length of hospital stay, patient diversion, emergency department waiting times, process improvement, patient flow
- MeSH terms
- Emergency Service, Hospital, Quality Assurance, Health Care, United States, Technology Transfer
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