The time it takes to get treated at emergency rooms in the United States is on the rise, but Torrance Memorial is trying a new method to reduce the wait.
This past June, a team of physicians, nurses and other staff came together to improve operations in the Emergency Department (ED) by utilizing the Lean Operating System, Toyota’s model for process improvement. While exploring solutions, the group examined ways to ensure every ED patient arriving between the hours of noon and 10 p.m. would be seen by a physician within 60 minutes of stepping foot in the door. The hours of implementation were chosen because the department is busiest during that time period.
Under the former system, a nurse conducted a preliminary examination upon the patient’s arrival to document vital signs. The patient then sat in the waiting room until one of 33 Emergency Department treatment rooms became available so he or she could be seen by a physician. Under the improved process, a physician now sees the patient while he or she is in the ED waiting room, then determines who most urgently needs to be moved to an ED bed.
“Lean is an operating system that uses a problem-solving model to address issues and inefficiencies,” explains Collette Baeza, RN, director of the Torrance Memorial Lundquist Emergency Department. “Lean empowers people to problem-solve and make the work environment better. It focuses a person’s efforts on fixing the barrier or eliminating it and bringing everyone closer together.
Torrance Memorial Has A Busy Emergency Department
“Generally, patients brought in by ambulance are in critical condition and are immediately seen by physicians in a treatment room of the department. For patients who walk in or drive in on their own, the wait times in the ED can be unknown,” says Baeza.
The changes made after using the Lean process improvement model have significantly sped up this process. Both a nurse and physician are now in the waiting area, known as triage, to diagnose the urgency of a patient’s situation.
First, a patient is visited by a nurse, who assesses the severity of the illness and assigns a level using a five-point severity index tool, which addresses the severity of the patient’s illness or injury. Patients who arrive in pain are treated for pain as soon as possible after this process is completed, but for most this is after a physician in triage evaluates them.
If it is less severe, he or she visits the physician in the waiting area, who will conduct a brief medical exam, ask questions and order blood work or tests such as EKGs or CT scans to start the diagnostic process. So the wait time in triage is productive, and when that patient is transferred to the physician in the unit’s main treatment area, results of the tests may be in, and the doctor is closer to initiating a course of action.
“We have always had a nurse working in the lobby to triage our patients, but it is outside a nurse’s scope to diagnose patients, as well as order tests and medication,” says Baeza. “This new system decreases the risk that a sick patient will become frustrated with the wait and leave without ever being seen by a physician.”
Heather Shay, vice president of Clinical Quality and Accreditation, brought the Lean operating system to Torrance Memorial after seeing the value of it in other industries such as auto manufacturing and aviation. “The intent is to create an operating system throughout Torrance Memorial and a culture where we continuously improve how we do our work. The outcome is to add value to our customers and eliminate waste,” says Shay.
“We look at the process through the eyes of the customer, or by going to the shop floor. In healthcare, that could be the patient or the employee. You examine the journey that customer or employee takes from the time they enter the door to the time they are discharged,” she adds.