A local low-acuity emergency department wants to improve its patient flow. The facility has as its goal that 85 percent or more of the arriving patients will be seen by a doctor in 60 minutes or less. Currently, the facility is not meeting that goal. 

An initial, high-level process map has been developed (see Figure 7.5), along with some observations from an outside team of analysts. Your task is to determine what else may be done to help this facility better understand the reasons it has been unable to meet its service-level goal. Specifically, explain in detail how each of the eight approaches listed might help this facility in determining where it should focus its change efforts if it wants to meet its current service-level goal.

Observations Time spent at registration is consistently less than five minutes.

 Time spent in triage is consistently less than five minutes. 

Time spent in the waiting room is highly variable (five minutes to 100 minutes) and depends on the patient’s acuity (more severe patients are seen more quickly). 

Time spent in exam room is highly variable (10 minutes to 100 minutes) and depends on availability of doctor and extent of testing required. 

Time spent at discharge is consistently less than five minutes.

The facility operates 15 hours a day, seven days a week.

 The facility has 10 patient exam rooms, two full-time doctors, one part-time doctor, two nurses, and one triage nurse. 

All patient diagnoses must be entered into a computer system by the doctor at the conclusion of a patient’s exam.

Approaches to Consider

 Process mapping (for subprocesses). 

Value stream mapping. 

Staffing and workload management 

Productivity analysis. 

Analysis of data for key emergency department productivity measures.

Emergency Room Acuity 1 EXIT Patient Patient Acuity Patient to Discharge Arrives to Triage 2-5 Room Registration Triage Station Waiting Room Examination Room