Healthcare Engineering: No Wait Emergency Medicine through PDQ
Dr. Christopher J. DeFlitch, M.D. | Chief Medical Information Officer (CMIO) | Penn State Hershey
Vice chair, Department of Emergency Medicine
- With no waiting room in the facility, Penn State Hershey used technology, simulation, and process innovations to redesign care and patient flow
- Use of “Clinical value streams” and “PDQ: Physician-directed Queuing” to achieve dramatic results
- Showing how the “science of flow” can be used with a couple of easy tricks and practical tools
Improving Throughput Dynamics by Fixing the Front End
Dr. Gregory Smolin | Memorial Hospital | York, Pa.
- Without the benefits of a large PI team, the Physicians led a boot-strapped effort to institute a series of effective changes that led a new paradigm of patient flow
- Quick, Physician-led change resulted in LWOT’s dropping from as high as 7 percent to less than 1 percent on most days
- Variable Physician coverage in key areas of patient flow (e.g. triage) , driven by volume and arrival analysis
- Maximized utilization of all ED resources to optimize flow by utilizing a "Charge Physician" role
- Examples of areas of improvement will include: Decrease in door to doctor time, decrease in LWOT rate, decreased bed utilization time, decreased door to pain med interval, improved patient satisfaction
Designing and implementing the ED door to doc model for safer care
Twila Burdick, Kevin Roche | Banner Health | Phoenix, Ariz.
- Banner’s Door To Doc (D2D) Split Patient Flow model reduces the time for patients to see a provider and increases ED capacity
- New flow models and processing for low-acuity patients
The power of Lean principles and queuing theory for dramatically improving ED throughput
Dr. Jody Crane | Mary Washington Hospital | MedStar Health | Fredericksburg, Va.
- Deliberate use of Lean principles, queuing theory, and existing resources to drive continuous process improvement in a large community hospital
- A focus on nimble and rapid improvements
- Using a structured, systematic approach to improvement involving an empowered front line staff proved vital to realize sustained improvement without heavy-handed management
Rapid Evaluation Units
William Jaquis, MD, FACEP | Chief, Department of Emergency Medicine | Sinai Hospital of Baltimore | Baltimore, Md.
- Instituted several REUs (Rapid evaluation units) for care of specific patient populations
- Effective use of mid-level providers (MLPs) to reallocate tasks and improve workflow
- Staging area for patients with specific acuities
- Used specific queuing methodologies to redirect flow
- Creating a multi-stream model for getting the patient to a provider for expedited care
No-wait (for bed) ED
Richard MacKenzie MD FACEP | Chair, Emergency Medicine | Lehigh Valley Health Network | Allentown, Pa.
- LVH has a long track record of success through the applications of Lean principles, sound project management, data analytics, and simple queuing theory.
- With a focus on hospital-wide flow, LVH has achieved success in unclogging the "back door" (getting the admission upstairs) that can be translated to small and large EDs.
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