Patient Throughput

ER Wait Watcher - Which emergency room will see you the fastest?

The PRO Publica website shows current and average wait and service times for most hospitals in the U.S. and roll-ups by state. How does your hospital stack up?

The Seven Tenets of Healthcare Process Improvement

In this presentation, Lou Keller calls on 45 years of experience dealing with every manner of healthcare planning, management, design, control and implementation problem to paint a compelling and entertaining picture, not just of the critical differences between healthcare and all other management systems, but how to use an in-depth understanding and appreciation of those differences to achieve continual and lasting healthcare process improvement.

Cleveland Clinic's value-based care team improves patient wait times, saves costs

Cleveland Clinic has found ways to reduce cost and increase throughput by adding support staff for primary care visits.

Interventional radiology throughput optimization

This paper is a case study of work done at Parkland Memorial Hospital in Dallas, Texas, to improve interventional radiology throughput with the main objective of reducing patient wait times and avoiding costly capital investment.

Can lean tools help crack the medication safety code?

Joanie Ching, RN MN, Administrative Director of Quality and Safety, blogs about how Virginia Mason Hospital in Seattle is abandoning batch administration of medications to improve patient safety. By going to just-in-time medication administration, nursing workload has been leveled, medication errors have been reduced, and nurses are better able to respond to patient needs.
Editor's note: Workload leveling and smaller batch size, like many other "lean tools," are industrial engineering concepts that have been well understood for many decades. It appears that a lean approach has helped Virginia Mason to discover the benefits in this novel application. 

Modeling and optimizing emergency department workflow

The authors of this presentation describe how industrial engineering research improved patient access and reduced cost by applying a machine learning simulation approach at Grady Health System in Atlanta.

Management tools for internists, designing the patient schedule

This article describes best practices for setting up a productive internal medicine clinic. Many of the practices described in this article can be applied for improved throughput and patient satisfaction in other types of ambulatory clinics.

 Case study series on pneumonia care improvement measures: Improvement strategies of top-performing hospitals

The following synthesis of performance improvement strategies is based on a case study series published on The Commonwealth Fund website, The hospitals profiled in this series were identified based on their performance on the pneumonia care improvement measures that are reported to the Centers for Medicare and Medicaid Services. Please see the case studies for a full description of the selection methodology.

Increasing cath lab capacity through Six Sigma - iSixSigma

This online article describes capacity improvement at the University of Pittsburgh Medical Center (UPMC) catheterization lab. The cath lab is a particularly challenging environment because of high-volume, high-mix, and the need to meet scheduled, emergent, and urgent patient needs.

Here's how a Cincinnati ER cut its wait time by 70 percent - The Cincinnati Business Courier

Dr. Stephen Feagins, vice president of medical affairs, describes how ER wait times were reduced by 70 percent at Mercy Health's Anderson Hospital in an interview with the Cincinnati Business Courier.

Is Your ED Optimized? Advanced Healthcare Network Executive Insight

Dr. Crane addresses a host of issues in this article for improving ED performance including the application of queuing theory, demand matching, and more frequent budgeting.

Online queuing theory calculator

Have you lost that disk from your college days that had a queuing theory calculator on it? There is at least one online queuing theory calculator that may meet your needs in your next queuing analysis.

Staffing an ED appropriately and efficiently, ACEP News

Much attention is given to RN and other support staffing in the Emergency Department while neglecting to look at ED provider staffing. This article in ACEP news gives some recommendations for provider staffing that may be the most important driver of patient throughput in your ED.

Shortening hospital stays for lower-risk patients after a severe heart attack

This guest post in the Harvard Business Review describes how the Minneapolis Heart Institute has started to use a validated risk-prediction tool to distinguish between patients who require an extended hospital stay after a severe heart attack and those who can safely go home within 48 hours. Shortening hospital stays for lower-risk patients after a severe heart attack.

Patient and resource scheduling of multi-step medical procedures in nuclear medicine

Managing patients in nuclear medicine departments is a very challenging problem with limited research reported in the literature. The complexity involved in this healthcare setting makes this problem unique. In this paper, the authors derive and implement algorithms for scheduling nuclear medicine patients and resources.

Quality Improvement in pharmacy inventory control - 2013 Healthcare System Process Improvement Conference presentation

This presentation covers many aspects of quality improvement in the pharmacy with a focus on improving flow. This presentation covers the project from the lean aspect as well as information technology, facility redesign and human factors.

The leaving without treatment reduction plan success story: Advocate Trinity

An improvement team at Advocate Trinity Hospital in Chicago addressed the issue of a high rate of "left without being seen." This presentation at the 2012 Healthcare Systems Improvement Conference describes how an improvement team used information systems and analytical approaches to gather information on the root causes for problems and potential solutions in the ED. Leadership rounding throughout the ED, establishing effective treatment protocols and finally, front loading medical orders to help expedite patient treatment and prompt patient disposition. After implementation of the above planned measures, the LWOT percentage reduced from the highest rate of 12.4 percent in July 2009 to 1.1 percent in June 2011.

JAMA - Lean management systems could actually save lives

Management systems focused on standardization strategies like lean result in better health outcomes and lower mortality rates, according to a new JAMA report based on a study from the Oregon Health and Science University.

A lean look at hospital readmissions

Physicians at Denver Health provide a presentation on reducing readmissions using a lean approach. Denver Health has been applying lean methods to clinical and nonclinical improvement for more than seven years and is nationally recognized for performance in patient safety and outcomes among large teaching institutions.

Real-time forecasting of pediatric intensive care unit length of stay using computerized provider orders

The authors conducted a retrospective cohort study to describe a model to provide real-time, updated forecasts of patients' intensive care unit length of stay using naturally generated provider orders. The study was based on more than 2,000 admissions to a pediatric intensive care unit. The model was designed to be integrated within a computerized decision support system to improve patient flow management.

Surviving the global healthcare perfect storm

The authors describe the application of operational planning and capacity management methods to improve patient care, improve revenue, and lower costs. Article  

The Joint Commission's new patient flow standards 

The Urgent Matters e-Newsletter breaks down how hospitals will be impacted by the new Joint Commission patient flow standards being put into effect in 2013 and 2014. The major focus of the new standards is to demonstrate systems for improving flow in emergency departments.

Sustaining improvement in door-to-balloon time over 4 years, The Mayo Clinic ST-Elevation Myocardial Infarction Protocol

The online journal, Circulation: Cardiovascular Quality and Outcomes, describes a multi-year effort at the Mayo Clinic to meet the American College of Cardiology/American Heart Association guidelines for door-to-balloon time (DTB) < 90 minutes for non-transferred patients with ST-elevation myocardial infarction (STEMI) who undergo primary percutaneous coronary intervention.

Coordination of multiple departments to improve ED throughput, OhioHealth 

In this presentation the authors provide a case study of the need to coordinate with departments outside of the ED to improve ED patient flow. Some of the results reported include eliminating 16 process steps for bed assignment, reducing admit order to patient orders by more than 50 percent and increasing the number of before noon discharges by more than 70 percent.

Reducing length of stay using service line lean concepts

In this presentation at the 2011 SHS Conference, Jonathan Flanders describes how a 400 bed hospital reduced average LOS for Hospitalist patients by 1.0 day using lean concepts applied at the service-line level. The presentation is a comprehensive case study for the application of lean and six sigma tools. The use of multi-level value stream mapping applied to an inpatient care unit will be of particular benefit for readers struggling in this area.

Industrial and systems engineers cure some of healthcare's ills - Watson Institute for Systems Excellence at Binghamton University

A recent feature in Binghamton's Watson Review describes ongoing healthcare improvement research at the Watson Institute for Systems Excellence (WISE). Ongoing healthcare research at WISE includes research in ED throughput and supply chain. WISE researchers collaborate with a number of hospital systems including Vitua, Mayo, and Wilson and Binghamton General Hospitals. Thirteen research assistants in the WISE program have recently been placed in healthcare organizations.

Lessons learned from moving to Web-based surgical requests

The authors delivered a presentation and paper at the 2011 SHS Conference providing a comprehensive case study of how the Sir Mortimer B. Davis-Jewish General Hospital in Montreal, Quebec, moved from a paper surgical request process to a web based system. The lessons learned described by the authors will be valuable for anyone undertaking a similar large scale IT change.

Undergraduates in action - Utilizing lean techniques for improved patient and information flow, UMass Memorial Hospital

Students at Worcester Polytechnic Institute and in coordination with UMass' Center for Innovation and Transformational Change examined how lean tools can eliminate non-value added work, improve resource management, and create lean flow at the UMass Memorial Hospital. After implementing a number of changes, the team saw a reduction in patient throughput time, elimination of defects in the chart tracking process, and a decrease in stocked inventory.

Improving pediatric emergency department patient throughput and operational performance

A multidisciplinary team working at the Rady Children's Hospital in San Diego, Calif., was formed to improve ED throughput. Based on comprehensive variability analysis the team implemented a number of changes including daily performance reporting, a fast track for lower acuity patients, and standardized nurse and physician rounding. The changes resulted in a 10 percent lower length of stay and a 50 percent reduction in left without being seen. These changes are planned to improve revenue by $782,000 to be budgeted in the next fiscal year.

Helping a hospital shine 

In an article previously published in Industrial Engineer magazine, industrial engineering researchers at Clemson University assisted Cannon Memorial Hospital in Pickens, S.C., in a number of hospital-wide and service specific improvements resulting in increased efficiency.

Case study on patient flow improvement, streamlining admissions from the emergency department

In a case study on the AHRQ website, the 340-bed Forbes Regional Campus of Western Pennsylvania Hospital developed a number of strategies to reduce delays in patient admission and discharge resulting in improved patient flow.

Patient tracker

A case study of a centralized patient tracking system at Sentara Careplex Hospital in Hampton, Va. The case study shows how Sentara was able to reduce patient registration labor by over 50 percent and save over $300,000 per year.

 Improving hospital-wide patient flow at St. Francis Hospitals and Health Centers in Indiana 

In a presentation at the 2010 SHS/ASQ Healthcare Division Conference, Matthew Pierce, Nursing Manager, and Joseph Swartz, Director of Business Transformation, presented on improving hospital-wide patient flow using a Define Measure Analyze Improve and Control (DMAIC) framework.  Among many of the improvements cited was a 60% reduction in delays for critical care admissions from the ED.

Hospital Operating System Unleashing Throughput Potential

The fragmentation of a hospital’s activities across departmental operational silos propagates waste, compromising throughput. The assertion of this white paper is that a hospital will not be able to manage throughput for the achievement of its purpose until it becomes a system of interconnected activities. Executive Summary | Full white paper 

The Importance of Communication for Patient Satisfaction

A discussion of survey results regarding communication between providers and the patient. The visit quality as perceived by the patient increases with fewer communications.

Adding Value to the Surgical PAT Process

Using Lean Six Sigma tools, a hospital redesigns its PAT department process so that all charting is completed 72 hours prior to the day of surgery.

Management Engineers

Management Engineering: What is it?

An Introduction to External Funding for Health Care Improvement

Management engineers may need money to implement healthcare improvement.  This article outlines several potential funding sources.

Improving Medical Equipment Availability at Barnes-Jewish Hospital 

One hospital details improvements to their medical equipment retrieval, cleaning, and distribution process.

Sustaining VAP Bundle Compliance in the ICU: A Model of CQI

Using Lean Six Sigma tools, a hospital redesigns and implements new ICU protocols for patients on mechanical ventilation.  The article details how the initial sustainability effort failed, but was brought back into long-run control.

Optimizing Caregiver Workflow in a PICU

Physician and Nursing roles and responsibilities within a PICU are redefined using lean tools to decrease LOS while increasing outcomes.

Value Stream Mapping Got You Down? The Problem May Not Be You.

When applying value stream mapping, don't forget that sometimes patients will need to be grouped just like part families - and each of those may need a unique VSM.

In by 9 Out by 6 - Level Loading

A CT scan department has its demand smoothed.

Paging Dr Toyota

Discussion of applications of lean within the OR.

Redesigning Emergency Department Care Delivery Focusing on Patient Safety

An ED is redesigned after patient flows were modelled using queuing theory.

Simulation Medication: Studies Show Patient Flow Improvement

The process of creating and achieving approval of an ED simulation is discussed.

Attacking Waste and Variation Hospital-Wide: A Comprehensive Lean Sigma Deployment

Improvement projects in surgery, nursing, and the ED are discussed.  The process of moving a hospital towards adoption of Lean Six Sigma is also described.

Creating A Patient Centered Access Management System

Improvements to a provider appointment-making system are motivated, tested, and sustained

Improving Health Care Quality in a Pediatric Ambulatory OR Setting

Improvements to a pediatric OR are proposed and tested with simulation.

Utilizing Industrial Engineering Student Teams to Benefit Management Engineering Efforts

An ED lean project is discussed, highlighting some advantages that undergraduates can bring when partnered with professionals in the field.

Encouraging Management Engineering in Safety Net Hospitals

Several change management projects are covered in brief, moving rapidly through high-level descriptions of problem / intervention / impact steps.

In by 9 out by 6 - Load Leveling

Detailed description of a lean project to improve TAT in the CT Scan department.

Building Lean From the Ground Up

The surgical admitting process is targeted with a lean event.  Current and future state is described, the process of improvement is shown, and results are discussed.

Get em In - Get em Out

Multiple projects and results are discussed in the goal to continuously improve patient flow.

StaffingMatrix - A Powerful Tool for Balancing Staffing and Demand

A hospital implements improvements in staffing to hourly changes in RN demand.

Using the Theory of Constraints to Supercharge Inpatient Throughput

A consulting group presented their throughput ideas, including reasons why some department-specific projects fail to realize proposed improvements.

Improving Patient Flow from the ED to a Nursing Unit

A lean event focused on patient flow out of the ED was conducted, and results are discussed

Enhancing Performance Excellence: Total Emergency Services Redesign

All processes in an ED are redesigned, with multiple outcomes showing improvement.

The Journey Toward a Lean ED

A 100,000 annual visit hospital ED is redesigned using lean principles. Wait times decrease and pt satisfaction and revenue increases.  Simulation shows further viability of new processes.  This presentation is made by a MD who became a lean coach.

Applying Redesign Principles to Design ED and Hospital Patient Flow Processes

This is an overview of several lean redesign projects in the ED with overall solutions discussed and analyzed.

A Revolution in ED Patient Throughput Management

ED throughput process improvement projects are discussed.  The presenter is a MD.  Several changes are shown with great results.

Turning the ED into Your Hospital's New Front Door

Multiple projects are performed to improve an ED.  Problems are stated and results are given.

Using Six Sigma to Improve ICU Patient Flow

A Lean Six Sigma project focusing on ICU throughput times is completed.  Lessons learned and successes are shared.

Key Performance Indicators: Relevant Metrics that Sell Results and Drive Ongoing Improvement

A discussion of the importance of metric and measurement accuracy during execution of improvement projects.

Improve Outpatient Clinic Access and Service with Lean Six Sigma

A lean project is done at a cardiac clinic.  Problem is to reduce wait time for an appt and cycle time of the appointment.  Results are discussed.

Optimization of Surgical Scheduling

An OR's case scheduling process is studied; improvement projects are proposed.

Optimization of Overtime Costs and Operating Room Utilization

A program is proposed that effectively confronts a majority of the issues with scheduling patient surgeries.

Design the Greatest Emergency Department - Applying Basic & Advanced Lean Healthcare Tools!

The author facilitates a lean educational journey through an ED.

Size Matters; How Big Does Your ED Need to Be?

A Premier consultant discusses lessons learned from performing many Lean ED projects during her career.

Applying SHS Conference Learnings Back at the Ranch

Emergent Care was redesigned to decrease wait time significantly.

Managing Variability in Patient Flow - Data, Process, Sustainability

Methods of confronting and smoothing the variability of patient flow are discussed.

Weekend Services: The Patient is Here, So Why Aren't We?

A 848-bed hospital is experiencing long LOS and targets ancillary service availability as one potential source of improvement. The project discussed tracks the data, demonstrates immediate results, and suggests future improvements.

Optimizing Cargiver Workflow in a New Pediatric Intensive Care Unit

A lean project generated proposals for rescheduling the providers' workload. During testing of the proposals, daily departmental volume was completed significantly earlier in the day.

Our Lean Journey Continues and What A Year It's Been!

Lean projects at Kaiser Permanente are detailed and discussed. The report is a system-level presentation showing many departmental improvements.

Lean in the Laboratory and Radiology: A Patient Throughput Imperative

Lean improvements within the radiology suite and laboratory workspace yield notable improvements. Project benefits are discussed.

Connecting the Revenue Cycle to the World Wide Web

A pre-registration Internet interface was successfully developed. Lessons learned and sustainability are also discussed.

Using Lean Techniques to Improve Turnaround Time and First Case Starts in the Operating Room

Turnarounds and first case starts are improved using a variety of lean techniques. Sustainability, achievement of buy-in and metric details are also discussed.

Improving Surgical Services Through Enhanced Ancillary Support

Lean improvement projects are performed within the supplies delivery function of a surgical services suite.