Evaluation of an Emergency Department Lean Process Improvement Program to Reduce Length of Stay

摘要: Study objective In recent years, lean principles have been applied to improve wait times in the emergency department (ED). 2009, an ED process improvement program based on methods was introduced Ontario as part of a broad strategy reduce length stay and patient flow. This study seeks determine effect this quality care. Methods We conducted retrospective cohort all visits at control sites during 3 waves from April 1, 2007, June 30, 2011, Ontario, Canada. Time series analyses outcomes before after difference-in-differences comparing changes with were conducted. Results before-after models among alone, 90th percentile did not change wave 1 (–14 minutes [95% confidence interval {CI} –47 20]) but decreased 2 (–87 CI –108 –66]) (–33 –50 –17]); median (–18 –24 –12]), (–23 –27 –19]), (–15 –18 –12]). waves, decreases observed time physician assessment, left-without-being-seen rates, 72-hour revisit rates. difference-in-difference models, which compared controls, associated no (17 –0.2 33]) increases (23 0.9 45]) (31 10 51]), modest reductions decrease assessment alone. Conclusion Although reduced waiting times, it appeared that its benefits diminished or disappeared when sites, exposed system-wide initiatives such public reporting pay for performance. suggests further evaluation effectiveness is warranted widespread implementation.