Using Kaizen to Decrease Turnaround Time in the Emergency Department

This interprofessional collaborative approach will be accomplished using LEAN as a process improvement model. The principles of LEAN include increasing value to end users by eliminating waste, creating a smooth workflow with little or no delays, empowering frontline staff to make improvements to the processes, solving problems at the source, and continuous cycles of incremental improvement (Kaizen). The ultimate goal is to develop and test new ideas during the rapid process improvement workshop (RPIW) that could be implemented to create more reliable and efficient patient care processes that will, in turn, result in higher patient satisfaction scores. Patient satisfaction scores are an important surrogate marker for quality in patient care, therefore the success of this project will be measured by the interactive dashboards and patient satisfaction scores.

Turnaround time in the Emergency Department is a metric that every healthcare organization struggles with, including Florida Hospital Wesley Chapel. When the RN and the EMT have a high acuity patient, they may have to dedicate more time to that patient resulting in a delay to the next patient. The final is not having a dedicated phlebotomist in the emergency department. Needs/Problem Turnaround time in the emergency department is a metric that Florida Hospital Wesley Chapel is challenged with daily. Florida Hospital Wesley Chapel is one hospital within the West Florida Division of the Adventist Health System. The West Florida Division has set TAT goals for all hospitals within the division. Using a Kaizen Event for Process Improvement Over past 20 years the LEAN Leadership management style has introduced ways to improve daily processes in a healthcare environment by finding wastes and eliminating them.

“The foundation – the goal of LEAN– is continuous cost reduction through the elimination of waste” (Black & Miller, 2008). By involving everyone in “Kaizen” (continuous incremental improvement) the interprofessional team, made up people from every level of the organization, will use LEAN management principles to find process improvements for turnaround time for radiology contrasted studies in the emergency department. A Kaizen event, or rapid process improvement workshop (RPIW), will be set up and lead by departmental leadership and consist of the interprofessional team, which includes; hospital administration, departmental leadership, physician, nursing, laboratory, EMT, and radiology staff support. As interdisciplinary teams work together, they start to understand each other’s work processes, the steps involved and the time it takes to complete each task.

“History tells us repeatedly that the most powerful resources unavailable to companies is not technology, but people. Motivating and engaging employees is the key to a successful project” (Black & Miller, 2008). There is preliminary work that must be done by the administrative and the departmental leadership teams. Prior to the start of the Kaizen Event, the team leader will provide a turnaround time (TAT) dashboard that includes all CT exams requiring reported lab values. The radiology TAT that will be looked at will be the order to start time. m. Daily, from 3:30 p. m. to 4:30 p. m. They are also taking note of where the areas of greatest opportunity are. At the end of the day, the team will meet back in the classroom to discuss findings and update the VSM.

The team lead will summarize the finding for the team and what will be taking place on Day 3. DAY 3: (Brainstorm) The day will again start with a recap of the previous 2 days and a preview of Day 3. Day 3 is all about brainstorming ideas and creating a “future state” VSM. DAY 5: (change and sustain) Day 5 is all about monitoring the changes made on Day 4. These results will be reported out at the end of the day. While the work is being done in the Emergency Department, the team will be discussing and documenting any parking lot issues that were not able to be resolved during the RPIW and coming up with a plan and timeline for completion. This is also a great time to create a list of areas of opportunities for future Kaizen events.

A formal, final report should not have to be completed if the administrative and department leaders have been actively engaged during the RPIW. Application of Evidence Based Practice in reducing the emergency room turnaround time (TAT) Evidence-based practice (EBP) refers to an interdisciplinary approach used in clinical practice. For the past decades, EBP has gained ground because of the increased utilization in clinical practice. EBP started in the field of medicine as medicine as evidence-based medicine but it later spread to other fields like nursing psychology, social work, and education among others. Evidence based practice is a component of the scholar practitioner approach that entails utilization of current research literature in making treatment decisions. EBP requires integration of three basic principles namely the use of the best available research evidence putting into consideration whether and why a certain treatment works, clinical expertise in making clinical judgment and experience in order to quickly identify patient's sole health state and diagnosis, any risks and possible interventions, and consideration of patient preferences and values (Blick, 2013).

Dealing with patients can sometime be tedious because some have their own preferences and values. As a result, EBP model requires health practitioners to consider patient preferences and values. However, the patient should not be allowed to dictate the proceedings during any clinical test. In our context, using the EPB model will require those in the emergence room to put into consideration all patients preferences and values when delivering laboratory tests (Blick, 2013). This can be tedious but the health practitioner needs to be patient with all preferences and values. Blick, K. E. Providing critical laboratory results on time, every time to help reduce emergency department length of stay: how our laboratory achieved a Six Sigma level of performance. American journal of clinical pathology, 140(2), 193-202.