Every hospital seems to have the same problem: patient flow. One element that is critical to both patient flow and satisfaction is time, wait time and turnaround time. In 2009, Press Ganey found that ED turnaround times still average over four hours, basically unchanged over the last decade.
Robert Wood Johnson Hospital, winner of the 2005 Baldrige Award, has ED turnaround times of 38 minutes for discharged patients, and 90 minutes for admitted patients. They did this by systematically eliminating the delays between registration, triage, exam, lab, imaging, and discharge or admission/transport. Faster patient flow means greater patient satisfaction and more money. There is too much time between activities at most hospitals.
Example: …show more content…
It is conceivable that in an emergency room, patients can walk in and use the magnetic strip on their driver’s license, insurance card or credit card to check in and register using a kiosk.
2. Completing registration triggers a "pull" signal that brings the next nurse in the queue to collect the patient from the entry area and move them to an exam room.
3. Entering the exam room and gathering the patient 's vital signs triggers a pull signal for the next ED doctor in the rotation.
4. The doctor examines the patient with the nurse available and requests any tests or X-rays using a hand-held device that kicks off the orders.
a. The nurse draws any blood or other samples required and either: a) sends them to the lab for processing or b) uses point-of-care testing to get results in 11 minutes or less (approximately 70% of patients require lab work).
b. The nurse transports the patient to imaging if needed (approximately 30% of patients require medical imaging.)
5. Completion of the tests triggers a pull signal to the ED doctor to collect the results, diagnose and recommend treatment.
6. The doctor then initiates treatment.
7. Initiating admission kicks off a pull signal for a bed in the appropriate …show more content…
Instead of all being done manually, as most of this is now, it is all carefully orchestrated and technically linked to minimize all delay.
A discharged patient could be in and out of the hospital in 30 minutes. This same logic thought process can easily be applied to other areas of the hospital.
The Problem Is Often Not Apparent
Every department—ED, ICU, Med/Surgical nursing floors, radiology, lab, housekeeping, bed management, etc.—believe that they are performing their duties as well as they can.
Fact #1: The Patient Is Idle Most of the Time
Everybody seems to know how long it takes to do their job. But nobody knows how long the delays are between each of these steps. Start measuring the delays between steps in the patient 's care, because this is how Length of Stay increases and patient satisfaction decreases.
Fact #2: Walking is Waste
Any amount of time that a doctor or nurse or technician spends walking is waste.
Fact #3: Speed Is Critical to Patient Satisfaction
When the patient is handled in one, seamless interaction, there is less time spent learning what happened in the previous step (e.g., reading the chart) and more time spent with the patient. Handling a patient seamlessly also prevents the opportunity to miss a step or do a step
Robert Wood Johnson Hospital, winner of the 2005 Baldrige Award, has ED turnaround times of 38 minutes for discharged patients, and 90 minutes for admitted patients. They did this by systematically eliminating the delays between registration, triage, exam, lab, imaging, and discharge or admission/transport. Faster patient flow means greater patient satisfaction and more money. There is too much time between activities at most hospitals.
Example: …show more content…
It is conceivable that in an emergency room, patients can walk in and use the magnetic strip on their driver’s license, insurance card or credit card to check in and register using a kiosk.
2. Completing registration triggers a "pull" signal that brings the next nurse in the queue to collect the patient from the entry area and move them to an exam room.
3. Entering the exam room and gathering the patient 's vital signs triggers a pull signal for the next ED doctor in the rotation.
4. The doctor examines the patient with the nurse available and requests any tests or X-rays using a hand-held device that kicks off the orders.
a. The nurse draws any blood or other samples required and either: a) sends them to the lab for processing or b) uses point-of-care testing to get results in 11 minutes or less (approximately 70% of patients require lab work).
b. The nurse transports the patient to imaging if needed (approximately 30% of patients require medical imaging.)
5. Completion of the tests triggers a pull signal to the ED doctor to collect the results, diagnose and recommend treatment.
6. The doctor then initiates treatment.
7. Initiating admission kicks off a pull signal for a bed in the appropriate …show more content…
Instead of all being done manually, as most of this is now, it is all carefully orchestrated and technically linked to minimize all delay.
A discharged patient could be in and out of the hospital in 30 minutes. This same logic thought process can easily be applied to other areas of the hospital.
The Problem Is Often Not Apparent
Every department—ED, ICU, Med/Surgical nursing floors, radiology, lab, housekeeping, bed management, etc.—believe that they are performing their duties as well as they can.
Fact #1: The Patient Is Idle Most of the Time
Everybody seems to know how long it takes to do their job. But nobody knows how long the delays are between each of these steps. Start measuring the delays between steps in the patient 's care, because this is how Length of Stay increases and patient satisfaction decreases.
Fact #2: Walking is Waste
Any amount of time that a doctor or nurse or technician spends walking is waste.
Fact #3: Speed Is Critical to Patient Satisfaction
When the patient is handled in one, seamless interaction, there is less time spent learning what happened in the previous step (e.g., reading the chart) and more time spent with the patient. Handling a patient seamlessly also prevents the opportunity to miss a step or do a step