LifePoint CNO Susan Peach: Streamlining Hospital ED Patient Flow Through Lean Process Management

Many hospitals are working to streamline processes in the emergency department to reduce crowding, improve quality and boost patient satisfaction. Facilities have tried to reach these goals in several ways, including expanding the ED, implementing new technology and redesigning processes. Susan Peach, a division CNO at Brentwood, Tenn.-based LifePoint Hospitals, took a lean manufacturing approach at hospitals in her division to improve ED patient flow to eliminate waste and add value for the patient. Ms. Peach explains how this approach helped reduce wait times and overall ED length of stay and increased patient satisfaction.

Ms. Peach used Kaizen, a process improvement strategy within lean manufacturing, within her division's hospitals. Kaizen encompassed a three-day workshop in which front-line workers in the emergency department worked with a lean expert to understand value-added and non-value-added processes. ED staff and clinicians first mapped out the steps in the current ED process and then broke into groups to identify the non-value-added steps. The ED team then redesigned the process to eliminate the non-value-added steps, shorten the process and ensure patients receive timely care.

One of the changes the system made is streamlining the triage process by bringing patients immediately back to the triage room for assessment by a nurse. A staff member records the patient's registration information while he or she is walking to the room, eliminating the separate step that was previously used to collect registration data. The patient will then either return to the waiting room or remain in the exam room depending on the acuity of his or her condition. This redesign cut the length of the triage process by approximately 10 to 15 minutes.

Kaizen and the implementation of a redesigned process is typically a three-month project at each hospital, according to Ms. Peach. Her team at LifePoint Hospitals then monitors and measures results at the hospital for two years.

Results of the Kaizen process so far have shown improvements in "door-to-doctor" time — the time it takes for a physician to see a patient once the patient walks in the door — total time in the ED and patient and physician satisfaction. The average door-to-doctor time at hospitals before Kaizen was approximately 40 minutes to more than an hour. After the redesign, the wait was reduced to an average of 10 to 15 minutes. Total time in the ED was reduced from an average of two to four hours to approximately 100 minutes. In one hospital, patient satisfaction jumped 20 points in one quarter following Kaizen. "Patients are happier, doctors are happier and patients are actually getting better care," Ms. Peach says.  

Improving patient flow requires commitment by hospital leadership to support efforts in reducing wait time and moving patients through the system more efficiently. Ms. Peach suggests the hospital CEO and CNO be accountable for patient flow; if patient flow metrics are below benchmarks, leaders should consider inviting lean experts to the hospital to direct the Kaizen process. However, accountability for patient flow doesn't stop there. Hospital leaders should monitor process changes related to patient flow and maintain support over time to ensure practices do not revert to old habits. "A lot of process changes take some strong will and leadership to maintain," Ms. Peach says.

Although hospital leaders need to provide support for patient flow initiatives, front-line staff and physicians directly involved with patients in the ED need to cooperate to actually change practices. Motivating people to work together on patient flow was one of the biggest challenges but also yielded some of the biggest benefits of the patient flow project at LifePoint's hospitals, according to Ms. Peach. The system brought people together by showing them results of previous hospitals that improved flow and wait time. ED directors from these hospitals are also talking with other hospitals in the system to discuss the importance of working collaboratively. "One of the biggest advantages of the whole process is that the front-line people come together and understand how interdependent they are and how working together can improve the process," Ms. Peach says.


Another element of improving patient flow is educating staff and physicians on patient tracking technology and patient boards. This education should extend beyond the ED to other departments, such as the lab and radiology, so that everyone is aware of time-related expectations. "Once [other departments] understood that time is ticking and that the emergency department is truly a priority, [hospitals] lost time there as well," Ms. Peach says.

More Articles on Patient Flow:

5 Steps to Alleviate ED Overcrowding
4 Strategies Hospitals Are Using to Optimize Patient Flow

Moving ED Waiting Room to Home Pleases Patients, Improves Efficiency

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