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Improving handoff efficiency for admitted patients: A multidisciplinary, lean-based approach

Published:November 06, 2018DOI:https://doi.org/10.1016/j.ajem.2018.11.003
      Although Emergency Department (ED) crowding remains a national problem, efforts to improve ED process efficiency and optimize throughput can potentially increase functional ED capacity [
      • Institute of Medicine, Committee on the Future of Emergency Care in the United States Health System
      Hospital-based emergency care: at the breaking point.
      ,
      • Hoot N.R.
      • Aronsky D.
      Systematic review of emergency department crowding: causes, effects, and solutions.
      ]. As a frequently occurring process with potential for significant waste and complexity, handoffs between the ED and inpatient teams represent an opportunity to apply systems improvement science and reduce delays [
      • Paul J.A.
      • Lin L.
      Models for improving patient throughput and waiting at hospital emergency departments.
      ,
      • Asplin B.R.
      • Magid D.J.
      • Rhodes K.V.
      • et al.
      A conceptual model of emergency department crowding.
      ]. In addition, the inpatient handoff process represents the final bottleneck in patient progression through many EDs and thus is a particularly important area of focus given the theory of constraints and potential effects on ED and hospital capacity utilization [
      • Asaro P.V.
      • Lewis L.M.
      • Boxerman S.B.
      The impact of input and output factors on emergency department throughput.
      ,
      • Rogg J.G.
      • Huckman R.
      • Lev M.
      • Raja A.
      • Chang Y.
      • White B.A.
      Describing wait time bottlenecks for ED patients undergoing head CT.
      ,
      • White B.A.
      • Biddinger P.D.
      • Chang Y.
      • Greene B.
      • Carignan S.
      • Brown D.
      Boarding inpatients in the emergency department increases discharged patient length of stay.
      ]. Systems engineering methodologies have demonstrated success in other areas of ED process flow [
      • Langley G.J.
      • Moen R.
      • Nolan K.M.
      • Nolan T.W.
      • Norman C.L.
      • Provost L.P.
      The improvement guide: a practical approach to enhancing organizational performance.
      ,
      • White B.A.
      • Baron J.
      • Dighe A.
      • Camargo C.A.
      • Brown D.F.
      Applying lean methodologies reduces ED laboratory turnaround times.
      ,
      • White B.A.
      • Chang Y.
      • Grabowski B.
      • Brown D.F.
      Using lean-based systems engineering to increase capacity in the emergency department.
      ]. Therefore, we hypothesized that a multidisciplinary, Lean-based effort involving different stakeholder groups could achieve improved handoff process efficiency and reduced turnaround times.

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      References

        • Institute of Medicine, Committee on the Future of Emergency Care in the United States Health System
        Hospital-based emergency care: at the breaking point.
        (Available at)
        • Hoot N.R.
        • Aronsky D.
        Systematic review of emergency department crowding: causes, effects, and solutions.
        Ann Emerg Med. 2008; 52: 126-136
        • Paul J.A.
        • Lin L.
        Models for improving patient throughput and waiting at hospital emergency departments.
        J Emerg Med. 2012; 43: 1119-1126
        • Asplin B.R.
        • Magid D.J.
        • Rhodes K.V.
        • et al.
        A conceptual model of emergency department crowding.
        Ann Emerg Med. 2003; 42: 173-180
        • Asaro P.V.
        • Lewis L.M.
        • Boxerman S.B.
        The impact of input and output factors on emergency department throughput.
        Acad Emerg Med. 2007; 14: 235-242
        • Rogg J.G.
        • Huckman R.
        • Lev M.
        • Raja A.
        • Chang Y.
        • White B.A.
        Describing wait time bottlenecks for ED patients undergoing head CT.
        Am J Emerg Med. 2017; 35 ([2017 May 1]): 1510-1513
        • White B.A.
        • Biddinger P.D.
        • Chang Y.
        • Greene B.
        • Carignan S.
        • Brown D.
        Boarding inpatients in the emergency department increases discharged patient length of stay.
        J Emerg Med. 2013; 44: 230-235
        • Langley G.J.
        • Moen R.
        • Nolan K.M.
        • Nolan T.W.
        • Norman C.L.
        • Provost L.P.
        The improvement guide: a practical approach to enhancing organizational performance.
        2nd ed. Jossey-Bass, San Francisco2009: 36-37
        • White B.A.
        • Baron J.
        • Dighe A.
        • Camargo C.A.
        • Brown D.F.
        Applying lean methodologies reduces ED laboratory turnaround times.
        Am J Emerg Med. 2015; 33: 1572-1576
        • White B.A.
        • Chang Y.
        • Grabowski B.
        • Brown D.F.
        Using lean-based systems engineering to increase capacity in the emergency department.
        West J Emerg Med. 2014; 15: 770-776
        • Graban Mark
        Lean hospitals: Improving quality, patient safety, and employee satisfaction.
        Productivity Press, Boca Raton, FL2012