A LEAN Approach to Emergency Department Crowding in a Southern California Health System

Ching Che J. Chiu, Tina T. Tsai*, Rachele Hwong, JJ Stewart, Su-yen Wu, Sasha Yu, Nicole Chorvat, Spencer Liu, William Huang, Michael Agron, Jon Aquino, Eing-Min Chang, Steve Giordano, Donald Lorack, Howard Ternes, Matthew Lin, Jonathan Wu and Wen-Ta Chiu

A LEAN Approach to Emergency Department Crowding in a Southern California Health System.

Emergency Department crowding has been proven to lead to longer length of stay minutes per patient’s arrival. Within AHMC HealthSystem in Fiscal Year 2016, all facilities experienced a 6.3% census increase from 181,818 in FY 2015 to

The need for increased efficiency and effectiveness in meeting increased demand was
recognized by health system and emergency department leadership. AHMC implemented an ED initiative task force of 5 goals for all facilities to follow
and achieve by the end of Fiscal Year 2016.

This initiative required all facilitiesʼ EDs to achieve door to doctor time <30 minutes, ancillary turnaround time<60 minutes, total length of stay<150 minutes, left without being seen<1%, and Emergency Department Patient Experience of Care Top Box >70%.

AHMC utilized prospective improvement process tools such as LEAN, monthly site visits, best practice and quality meetings, and social media reviews. AHMC implemented an internal centralized online
data collection tool through all facilities and AHMC corporate with the ability to track Centers for Medicare and Medicaid Services mandated metrics.

By the end of FY 2016, AHMC hospitals reduced their LOS from over 200 minutes to 180 minutes, LWBS rates decreased from 3-5% to less than 1%, door to doctor times decreased to an average of 31 minutes, and EDPEC satisfaction scores increased from 44% to 50%.

AHMC’s EDsʼ significant improvement demonstrated the strong potential of replicating their efforts on improving patient experience and quality measures to other departments and community hospitals.

Emerg Med Open J. 2016; 2(2): 42-47. doi: 10.17140/EMOJ-2-129