Hospital reduces ED wait with lean management

Lean management techniques helped Lahey Clinic Medical Center, North Shore, in the city of Peabody, MA, boost patient satisfaction and reduce emergency department (ED) waiting times.

Lahey is a full-service hospital featuring a 24-hour ED, the only ED in Peabody. More than 17,000 patients visit the ED annually. In October 2007, Lahey partnered with an Ottumwa, IA-based consulting firm to coach hospital staff on the application of lean management skills by revisiting their processes in the emergency department and identifying more efficiencies to improve patient care.

The first problem identified was the increased volume of ED visits, which resulted in long wait times for patients, says Bob Schneider, senior vice president at the hospital. With the goal of preserving patient care, Lahey began a series of rapid improvement events to help physicians, nurses, and staff see work more efficiently in their daily tasks. Schneider says the goal was to improve patient flow and reduce waiting time. Facilitators led selected members of the hospital and patients in an intensive forum where new ideas for improvement were piloted.

When Lahey decided to pursue lean management practices in the ED, the organization had a particular interest in better serving patients not deemed in critical, urgent need of assistance, Schneider explains. These are patients who may present with symptoms like a sore throat or sprained ankle and often, when more critical patients enter the ED, these nonurgent patients take a back seat.

By following the lean management approach, Lahey developed new roles and work processes that addressed those issues and significantly reduced the wait time for all patients. First, Lahey added the role of "air traffic controller" jointly managed by the unit secretary and charge nurse with help from the triage nurses. It is now their responsibility to help monitor patient flow throughout the department and to match available physicians with patients who have been waiting long periods of time and match them up accordingly, Schneider explains.

Second, to address repetition of data collection from patients, Lahey revised its process to minimize the amount of information collected at registration and synthesize the process of nurses and physicians collecting information. Instead of having the triage nurse, primary nurse, and physician approach patients at different times, the triage nurse collects information at the time of registration, and the treating nurse and physician collect information from the patient together. The result: Lahey's information-gathering process is streamlined.

Finally, Lahey developed a "fast-track" process for noncritical patients. Rather than wait to see a physician, patients are now under the direct care of a nurse practitioner, with an attending physician overseeing their care, Schneider says. When it is determined at registration that a patient is not in critical condition, he or she is automatically put onto the "fast-track" list. The ED is currently building a new fast-track area with a separate waiting area and staff that will serve these patients in the future.

With the new processes Lahey has adopted, the average patient's time in the ED was cut almost in half, to the current 2.5 hours. Waiting time to see a doctor reached a record low, with 75% of all patients now seen by a physician in less than 25 minutes. As a result of the changes, 86% of Lahey ED patients now report that they would be willing to recommend the hospital's ED to a friend.


For more information on the lean management projects at Lahey Clinic Medical Center, North Shore, contact:

• Bob Schneider, Senior Vice President, Lahey Clinic Medical Center, North Shore, Peabody, MA. Telephone: (781) 744-5100.