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Jeremy Lau, Brendan McDermott, Chaitanya Prasanna Patwardhan, Sagar Ramesh Modale

Reducing the ED Treatment Time

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Outline

• Project Charter 3-4
• Define Phase 5-8
• Measure Phase 9-12
• Analyze Paase 13-16
• Improve Phase 17-20
• Control Phase 21-24

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Project Charter

• Problem Statement
• NY State Hospital treatment time is significantly above the national average
• Project Objective
• Goal is to reduce the length of stay in the emergency room
• Project Scope
• Treatment times in New York State Emergency Room Department

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Project Charter

• Response Variable:
• Treatment Time in minutes
• Defect Definition:
• Any treatment time longer than 90 minutes
• Quantification of Problem:
• Conditions: Inadequate staff, not enough equipment, excess number of patients
• Extent: National average is 90 minutes, NY State average is 170 Minutes
• Performance: Treatment times over 90 mins and satisfactory level of patients after discharge
• Time Frame: Data set looks at 2020 NY State averages
• Specifications: Reduced time of stay should result in improved customer satisfaction and increased revenues

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DEFINE

• SIPOC - Helped visualize the process from beginning to end

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• CTQ - Helped define key services that the patients needed

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• Histogram - Helped summarize and visualize the the wait times (discrete data)

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DEFINE – SIPOC

• Patient
• Nurse
• ED Doctor.

• Medical Records
• Patient Symptoms
• RX Information
• ED Activity Log

• ER Treatment

• Discharge Documents
• Prescriptions
• Physicians Notes
• ED Activity Log
• Empty ED Bed

• Patient
• ED Doctor
• ED Manager
• Nurses
• Lab Personnel

Suppliers

Inputs

Outputs

Customers

Process

Assign Patient to Bed

Assign Doctor to Patient

Doctor examines patient

Doctor orders tests

Doctor treats patient

Doctor discharges patient

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DEFINE – CTQ

Quality Of Care

Speed of Care

Scope of Services

Knowledge of staff

Friendliness

Cleanliness of facility

Ample amount of beds

Appropriate number of staff

Sufficient amount of tools and resources

funding

Staffing

Space

Up to date training, funding to hire the right people, hiring the best candidates

Safe, positive working environment, appropriate breaks and sleep

Space and funding

Funding, staffing/patient management system

Funding, a philosophy towards a commitment to leading edge technology

Critical to Quality shows priorities that need more attention to improve quality of care

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DEFINE – Histogram

Created a histogram to show treatment time frequencies in New York State Emergency Room department

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MEASURE

• Descriptive statistics - Summarized data to represent entire population to help analyze data easily and quickly

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• Capability analysis - Helped assess if the system is able to meet requirement specifications

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• Hypothesis test - Showed the distribution of data and helps assess the data to show any significant differences

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MEASURE – Descriptive Statistics

• Mean of data is 174.06 minutes
• Standard deviation is 37.72 minutes
• Minimum time of 104 minutes
• Median time of 169 minutes
• Maximum time of 287 minutes

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MEASURE – Capability Analysis

• Value of Cpk and Cp is 0.26 which is low.
• Not capable nor centered.
• Lower specification limit is 60
• Upper specification limit is 120
• The graph is skewed to left

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MEASURE – Hypothesis Test

• Null is set to 90 because that is the accepted average treatment time
• T-value of 20.06 which compares the data of what is expected under the null hypothesis.
• P-value of 0.00
• Reject null hypothesis, in favor of the alternative

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ANALYZE

• Flow chart- Graphical tool that depicts distinct steps of a process in sequential order

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• 5 Why- Fully understand the root cause of a problem so that solutions or improvements may be identified

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• Fishbone diagram- Graphical method for hypothesizing a chain of causes and effects, sorting out potential causes, and organizing relationships between variables

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ANALYZE – Flow chart

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Treatment process from assigning a bed to discharge

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ANALYZE – 5 Whys

Reason for treatment time delay

Lack of beds

Doctor’s appointment

Treatment time delay

1st Why

2nd Why

3rd Why

4th Why

5th Why

Compromises

Less Beds

Funds

Sponsorship

Improper hospital setting

Doctors are not present

Schedule of doctors

Other commitments to other hospitals

Lack of Doctors

Not proper recruitment

Step wise Process

Process structure

To have a smooth procedure

To reduce rush on a particular instrument

Increase in number of patients

Lack of support staff

No recruitment

Capacity

Infrastructure

Funds

Sponsorship

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ANALYZE – 5 Whys

Parts missing

Different part number

Sage shows location, but not in location physically

Receiving person says there is not part like this

1st Why

2nd Why

3rd Why

4th Why

5th Why

Ordered under that number

Purchasing did not change the PO

Maybe Engineering did not notify that the P/N is changed

Received under that number

Incorrect label

Personnel error

No trained/ lousy work

He didn't see it on SAGE

Didn't try to investigate

Didn't know how to Investigate/Lazy?

Received under that number

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ANALYZE – Fishbone

Fishbone diagram shows the causes for the patient length of stay in the emergency room department

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IMPROVE

• Selection matrix - Chart that helped identify, analyze, and rate the strength of each potential solution

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• 5’s - Helped mapped out the workplace to make it clean, safe, and well organized to reduce waste and optimize productivity

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• Improved flow chart - Helped visualize the steps of the process in sequential order

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IMPROVE – Selection Matrix

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IMPROVE – 5’s

Created a standard multifunctional room

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IMPROVE – Improved Flow Chart

Improved flow chart boxed area shows new process, right area shows old process

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CONTROL

• SOP - Standard operating procedure helps describe the step-by-step process

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• Mistake proofing - Helped make whoever is restocking or reorganizing the equipment avoid any possible mistakes and defects by preventing, correcting, and drawing attention to human errors as they occur

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• Checklist - Helped ensure that all tools and equipment are back in designated spot

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CONTROL – NEW SOP

New SOP was created for new material equipment room with instructions for placement of tools

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CONTROL – Mistake Proofing

Standard multifunctional room with areas labeled and colored coded

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CONTROL – Checklist

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Questions

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References

D'Angelo, J. (2020, September 28). Five challenges facing emergency medicine. Five challenges facing emergency medicine | Northwell

Health. Retrieved November 22, 2021, from https://www.northwell.edu/news/five-challenges-facing-emergency-medicine.

Individual Hospital Statistics for New York. American Hospital Directory - Individual Hospital statistics for New York. (n.d.). Retrieved

November 22, 2021, from https://www.ahd.com/states/hospital_NY.html.

https://www.northwell.edu/news/five-challenges-facing-emergency-medicine - Fishbone data reference

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