THE IMPLEMENTATION OF LEAN STRATEGY TO ALLEVIATE OVERCROWDING IN EMERGENCY ROOM: NARRATIVE REVIEW

Yani Oryza, Jaslis Ilyas

Abstract

Background: Emergency Room (ER) of hospital worldwide undergoes significantly challenging problems; overcrowding patient leads to block the access, causes discomfort and increases demands to be served by medical personnel immediately. To overcome these problems, the ER needs to implement lean strategies. This study presents a narrative review aimed to identify whether there is a positive impact of the lean implementations in overcoming the overcrowded ER or not.

Methods: This narrative review explores the current literature from an online database and highlights the lean strategies adopted by several ER to reduce overcrowding and delaying and to streamline patient flow. Literatures without data on waiting time, length of stay (LOS), and untreated patients leaving the ER, will be excluded from this review. The types of intervention were grouped into team triage, streaming, fast track, point-of-care test (POCT), and nurse-requested x-ray.

Results: The evidence of lean intervention is beneficial in reducing patients’ waiting time and length of stay (LOS). Fast track reduces the length of waiting time, LOS, and the number of untreated patients by physician. Team triage consisting of appointed doctors and nurses also has a positive impact on shortening the waiting time. There is not enough evidence to suggest that streaming, POCT early in arrival, and x-rays by nurses can reduce waiting times and LOS.

Conclusions: The implementations of lean strategy have a positive impact in shortening the waiting time and LOS, and help speed up the patients’ flow and access to other supporting units. 

Full Text:

PDF

References

Paul Richard Edwin Jarvis. Improving emergency department patient flow. Clin EXp Emerg M 2015. 3(2):63-68 http://ceemjournal.org/upload/pdf/ceem-16-127.pdf

Oredsson S, Jonsson H, Rognes J, Lind L, Göransson KE, Ehrenberg A., Asplund K, CastrénM, Farrohknia N. A Systematic Review Of Triage-Related Interventions To Improve Patient Flow In Emergency Departments. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2011, 19:43 doi:10.1186/1757-7241-19-43

Polly Davenport. The relationship between emergency department wait times and inpatient satisfaction. Ann Arbor: The University of Alabama at Birmingham; 2014.

Carter EJ, Pouch SM, Larson EL. The Relationship Between Emergency Department Crowding and Patient Outcomes: A Systematic Review. Journal of nursing scholarship: an official publication of Sigma Theta Tau International Honor Society of Nursing / Sigma Theta Tau. 2014;46(2):106-115. doi:10.1111/jnu.12055.

Aacharya, R. P., Gastmans, C., & Denier, Y. Emergency department triage: An ethical analysis. BMC Emergency Medicine 2011, 11, 16. doi:http://remote-lib.ui.ac.id:2073/10.1186/1471-227X-11-16

Lawal AK, Rotter T, Kinsman L, Sari N, Harrison L, Jeffery C, Kutz M, Khan MF and Flynn R. Lean Management In Health Care: Definition, Concepts, Methodology And Effects Reported (Systematic Review Protocol) Systematic Reviews 2014; 3:103. doi:10.1186/2046-4053-3-103

Ng D, Vail, Gord, Thomas S, Schmidt N, R.N. Applying the Lean principles of the Toyota Production System to reduce wait times in the emergency department. CJEM : Journal of the Canadian Association of Emergency Physicians 2010 01;12(1):50-7.

Toyota Production System http://www.toyota-global.com/company/vision_philosophy/toyota_production_system/

Holden, Richard J. Lean Thinking in Emergency Departments: A Critical Review. Annals of Emergency Medicine 2010; 57 3: 265

– 278. doi:10.1016/j.annemergm.2010.08.001

Crawford K, Morphet J, Jones T, Innes K, Griffiths D, Williams A. Initiatives to reduce overcrowding and access block in

Australian emergency departments: A literature review. Collegian. 2014; 21, 359-366

http://dx.doi.org/10.1016/j.colegn.2013.09.005

Chan SSW, Cheung NK, Graham CA, Rainer TH.. Strategies and solutions to alleviate access block and overcrowding in

emergency departments. Hong Kong M J. 2015; 21 (4):345–52 DOI: 10.12809/hkmj144399

Bucci S, De Belvis AG, Marventano S, De Leva AC, Tanzariello M, Specchia ML, Ricciardi W, Franceschi F. Emergency

Department crowding and hospital bed shortage: is Lean a smart answer? A systematic review. European Review for Mical and

Pharmacological Sciences 2016; 20: 4209-4219

Harding KE, M.P.H., Taylor NF, PhD., Leggat SG, PhD. Do triage systems in healthcare improve patient flow? A systematic

review of the literature. Australian Health Review 2011 08;35(3):371-83.

Reinhardt MR. A Systematic Approach to Evaluation of Performance Deficiencies in Triage. Journal of Emergency Nursing 2017 Jul 01;43(4):329-332.. http://dx.doi.org/10.1016/j.jen.2017.01.003

Alavi-Moghaddam M, Alamdari S, Amini A, Forouzanfar R, , Shahrami A, Kariman H. Application of Queuing Analytic Theory to

Decrease Waiting Times in Emergency Department: Does it Make Sense? Arch Trauma Res. 2012;1:101–107. doi:10.5812/atr.7177.

Akbulut S, Baydin,A, Erenler Ak, Cetinkaya H, Guzel M, Karaca A, Turkoz A. Reasons for Overcrowding in the Emergency Department: Experiences and Suggestions of an Education and Research Hospital. Turkish Journal of Emergency Medicine. 2014;14(2):59-63. doi:10.5505/1304.7361.2014.48802

Crouch R, Dall’Ora C, Drennan J, Griffiths P, Jones J, Recio-Sauco A. Safe Staffing for Nursing in Accident and Emergency Departments. Draft Evidence Review. 2014; https://www.nice.org.uk/guidance/gid-sgwave0762/documents/safe-staffing- guidelines-accident-and-emergency-departments-evidence-review2

Refbacks

  • There are currently no refbacks.