The interval-level data identified one issue in particular as a problem: It was simply taking too long to get patients discharged. The emergency department switched to a synchronous discharge model whenever feasible, where healthcare providers and techs all work simultaneously; one person prints discharge instructions and explains medications while another gets a wheelchair, fits the patient with crutches, or removes an IV, for example.
They’ve used similar tactics to measure and reduce the time to move a patient from the ED to an inpatient bed.
The tracking system and electronic bed-management system are interfaced: When staff post a patient for admission in the RTLS tracker, the information is automatically sent to the bed management system, alerting transport and bed management staff.
“All those moving parts have to be aligned in order to launch that patient on the way to that destination bed. And so that again is an interval that we can flow map and say ‘OK, what are the barriers to moving a patient out of the department very, very quickly? What are the things that are holding us up? How can we combine steps? How can we make this notification better known to the staff that are taking care of the patient?’”
Another area of focus was the time it takes to treat and discharge low-acuity patients in the ED. “The average length of stay for those fast-track patients was running about two-and-a-half hours, which was way too long,” Laskowski-Jones says. “Fast track wasn’t fast.”
“We started working together with the frontline staff to identify better ways that we could flow this out,” he says. “And we really had a breakthrough when we engaged in Lean redesign efforts. We used the metrics that came out of the tracking—arrival at the front door through the system—and we looked at all those different intervals and we flow diagramed the process of fast track and we identified lots of waste and lots of queues developing in that system.”
The solution: Cut the number of supertrack patient rooms from six to two primary rooms, add one procedure room, and move everything closer to the front of the ED. “We want the low-acuity patient not to go very deep in the emergency department. The deeper you go the sicker you are,” Laskowski-Jones says.