DMAIC Project – Reducing Length of Stay in Emergency Department

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Does Lean Six Sigma work in a hospital? Yes! This DMAIC project example shows you how an emergency department in a rural hospital reduced the LOS, length of stay, to increase revenue and lower costs while delivering better patient outcomes. If you would like your hospital to have great outcomes like this one and create a culture of Continuous Improvement, give us a call or send us an email. Lean Six Sigma is working in healthcare!

Step 1: Define the Problem

“The nurses say we need to build a new, bigger, Emergency Department.”

Phil Eaton, CEO, Mountain West Medical Center

When Phil, the CEO of a regional hospital, told me they were considering adding a new wing with 10 or more beds to his Emergency Department… he looked concerned. It was going to be expensive. And while the surrounding communities were growing rapidly, he wasn’t sure it was necessary.

The feedback from the ED docs and nurses was clear. There are too many days when we are overcrowded and don’t have room for patients.

Step 2: Measure the Process and Gather Data

•After meeting with the ED Director, Scott, we agreed to gather some data. •We tracked the LOS (Length of Stay) for each patient through the ED. •I explained Little’s Law and the fact that long cycle times would increase the number of patients in the ED and could be the root cause of the problem.

Step 3: Analyze the Data

Now we had data! But what is the goal and how were we performing against it?

A 5 star hospital should process patients through the Emergency Department in 120 minutes (2 hours) or less.

To understand how well the ED was performing we needed a process capability chart.

Step 3 Continued: Analyze the Data and Find the Root Cause

This data was eye-opening. We didn’t identify one silver bullet but rather several processes that needed to be improved to reduce our Length of Stay. Most of the delays were caused by hand-offs between the ED and the lab or ED and radiology.

Step 4: Improve the Process… Kaizen!

•Armed with this data we kicked off a series of Kaizen Events (rapid process improvement projects). •Working with teams from the lab, imaging, and the docs, we found several creative ways to improve communication and reduce delays.

Step 5: Control the Process and Show Results

•We reduced the average Length of Stay from 185 to 150 minutes within a month then continued to work on projects until the average LOS was well under 110 minutes. •Patients love their new, faster, local Emergency Department at Mountain West Medical Center! There’s never a wait and they know they will get the best care without the wait. •The hospital has been operating with the same number of beds for over 3 years now and never has needed overflow.

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