Going Lean in the Emergency Department: A Strategy for Addressing Emergency Department Overcrowding

Rick G. Kulkarni, MD


December 14, 2007

A recent report by the Institute of Medicine titled, "Hospital-Based Emergency Care: At the Breaking Point," highlighted an inadequate system capacity for emergency care in the United States of America, with about one third of emergency departments on a daily basis routinely experiencing "overcrowding.[1,2]"

We know that overcrowding is associated with decreased patient safety and poor quality of care.[3,4,5,6,7,8] National healthcare polices and reimbursement trends, factors beyond the control of most individual physician leaders, have contributed to this crisis. Nevertheless, clinical leadership facing this situation at their hospitals can still address the problem by improving departmental operational efficiency.

One particular operational methodology called Lean is an ideal tool to help in achieving operational efficiency goals. Pioneered in the automotive manufacturing industry by Toyota, the Lean process is a management philosophy aimed at eliminating waste and improving overall customer value.[9] Being "Lean" is about understanding value from the customer's perspective and delivering exactly what is required at the right time with minimum effort and no waste in a safe environment.

Several emergency departments across the nation, including Yale-New Haven Hospital where I am the Medical Director, have successfully used the Lean methodology to dramatically improve performance on key metrics.[10] For example, at my hospital we reduced the time from the decision to admit a patient to transfer to the floor by 33% after applying Lean. A follow-up Lean intervention using the same staffing levels brought patient time to triage from a median of about 1 hour to a new benchmark of under 15 minutes.

In collaboration with hospital and nursing leadership, physicians can successfully use proven business methodologies, such as Lean, to achieve quantifiable gains in operational efficiency in their emergency departments.

We can overcome emergency department overcrowding one department at a time.

Go Lean!

That's my opinion. I'm Dr. Rick Kulkarni, the Medical Director for eMedicine.

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