Case Study: Rapid Lead Design - Emergency Department

Case Study: Emergency Departments A Deeper Look Emergency Departments have long served as the primary portal to healthcare systems. Designing for, and accommodating the peaks and valleys of census coupled with the need to always provide appropriate and timely emergency care makes the ED a complex challenge as more and more individuals rely on it for their primary care. Best practices are benchmarks at best and do not address the specific issues facing a particular client. We employ Lean Design strategies coupled with simulation modeling to help each client develop their ideal future state of operations and identify the true root cause of any barriers.

The Rapid Lean Design Process EMERGENCY DEPARTMENTS

CHALLENGE

PROCESS OVERVIEW Our Kaizen Events are geared to help clients quickly assess their current condition, map

As a result of an incomplete master plan

out patient flows impacted by the process, identify areas for improvement or streamlining,

renovation, all walk-in patients are funneled

and then establish an ideal future work flow. This future work flow is the critical first step in

through one semi-private triage station located

creating a viable and sustainable project.

directly inside of the ED’s front door. Long wait times, safety concerns, and patient confusion and dissatisfaction all led administration to engage Array to review the current operations and configuration in concert.

SOLUTION

The kaizen event is a swift and targeted multi-disciplinary workshop often consisting of two or three sessions. When appropriate, data is collected between sessions to better focus improvement activities.

Implementation Methods:

Through value stream mapping, direct observation and data collection and a multi-

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Observation & Current State Mapping

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Data Collection

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Future State Mapping

•

Develop the Road Map to Implementation

disciplinary improvement team was able to understand the root causes of current operational break-downs and develop a simplified future state employing a pivot nurse to pre-sort patients reducing the number that require a full traditional triage. Combined with minor space reconfigurations this new approach creates safe and distinct patient waiting areas to improve safety, satisfaction and reduce wait times.

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We were able to reduce the number of patients waiting in triage by more than half.

CURRENT CONDITIONS The emergency department (ED) of a tertiary care facility in western Tennessee averaging 95,000 visits per year recently underwent an expansion to increase capacity and provide new facilities. This addition was planned assuming a second phase of expansion that would complete the arrival, waiting and check in experience. The second phase was not completed, leaving the ED with a suboptimal entry configuration.

The ambulatory entry is located at the end of a long and narrow waiting space. This configuration yields a long distance between entry and triage. When the hospital sought Chest Pain Center designation, it needed to shorten the time from arrival to EKG for chest pain patients. The existing triage arrangement was seen as a barrier to this benchmark. In response, an auxiliary triage zone was created directly adjacent to the walk-in entry.

The satellite space included a registration clerk position and a semi-private triage alcove with a stretcher and EKG. The physical distance between the existing triage and the satellite triage led to the abandonment of the original location. All triage was now handled by the satellite zone. This led to long delays and sub-optimal patient care. The experience was further degraded due to the openness of the triage zone. No physical barriers fully enclosed the spaces.

Our kaizen event focused on the registration and triage process, and explored improvement opportunities to both the process and the physical environment.

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Implementation

Current Value Stream Map

CURRENT STATE

FUTURE STATE

After observing the process in action, we worked with a

Following the collection and review of current state data, the

multi-disciplinary team including nurses, patient care techs,

team met for a second workshop to define the ideal future

registration clerks, physicians and department leaders to

state.

map the current state process and identify opportunities for improvement.

DATA After mapping the current state the team developed a simple data collection tool. Over the course of one week, hospital staff collected a random sampling of patient encounters throughout all shifts every two hours.

Future Value Stream Map

At the conclusion of the workshop, the team had successfully mapped their ideal future state check-in and triage process for the ED. The new process featured a cross-trained clinical greeter who could initiate opening an encounter by reducing the information needed for a quick registration. This combined interview would allow the trained clinician to make an initial treatment designation, immediately routing fast-track patients and highly-acute patients directly to those service locations.

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Who We Are ARRAY-ARCHITECTS.COM Only patients not easily designated would then continue through the full triage process.

By immediately directing patients who may not require full

We Are Healthcare Architects

triage to the location best suited to serve them, the constrained entry area could be reconfigured to accommodate the reduced number of patients in a safer and more consistent manner.

We are a team of architects and designers with unique backgrounds, but we all have one thing in common - we share a strong desire to use our expertise and knowledge to design solutions that will help people in moments that matter most.

This focus makes us leaders in our field. There’s a degree of compassion, empathy, and sensitivity that goes into every project that we touch. It’s designing a nurse station with sight lines to every patient. It’s building a Behavioral Health facility without corners, so that patients are safe. It’s translating the operational needs through the technical details to fine tune the lighting system in a neonatal unit so caregivers can match the lighting to each baby’s stage of development. It is a deeper understanding, honed through relationships spanning decades.

ROAD MAP

Together, we discover optimal solutions with our clients. It is our four decades of specialization that allows for effective communication, collaboration and precision in the complex, changing world of healthcare.

Array’s Knowledge Communities ED Check-in/Triage Process Improvement

At the conclusion of the workshop the team reviewed the future state plan and identified barriers to its implementation. These

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key items provided the next steps for the hospital and quickly summarized the area requiring a more focused investigation.

SUMMARIZING CONTINUOUS IMPROVEMENT Our core mission is the same as that of our clients, improve the quality of our work, increase our efficiency, and motivate our staff to reach for success. At Array, we are establishing a culture of continuous improvement at all levels of our organization. We seek to empower members of our team to be agents for good change. We have re-designed our design process using Lean as a foundation for a unique Process-Led approach that better meets the needs of today’s healthcare organizations. We believe the transformative improvement that leading health systems, who have embraced Lean and other improvement approaches, have achieved is equally applicable to architecture.

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