Improving Emergency Room Efficiency Assignment Sample

Value Stream Mapping - Emergency Room

Introduction/ Background

A hospital is where someone comes to treat themselves or in some cases of emergencies, waiting in queues and losing valuable time and life-consuming issues nowadays. Using the analytical methodological technique of VSM, the hospital emergency healthcare systems and the patient experience of these systems were investigated from the standpoint of "Lean theory." This describes how VSM was used in our study. We investigate the effects of various care models on the patient experience while describing procedures for care and waiting periods between process phases. The data, which were gathered through the firsthand observation of patient itineraries at the four sites, serve as a basis for generating hypotheses and identifying potential issues with remedies. They also set the stage for the subsequent ethnographic chapters. Many initiatives have been started to improve the operating cost and efficiency of the way healthcare is provided in response to rising healthcare expenses. The field of delivery of healthcare operations needs to be seen in a new way, particularly in light of the fixed capacity available to supply healthcare services to an ever-increasing healthcare service demand. Several efforts have been launched to address the problems facing the health services sector. The most significant ones involve slowly enhancing a process or building new analytics based on unsuccessful mathematical or simulation models. Looking at options that aim to modernize the procedure while bringing about a long-lasting improvement to the sector is essential nowadays. Providing all the care and need is very much important in the emergency departments.

Main discussion

Analysis of the current VSM of the emergency department

After registering with the registration desk patients have to wait in the waiting rooms until their records are been passed to the attending nurses, after those patients are taken to the ER, then being examined by the nurses they decide what conditions they are in that time, after being treated by the nurses doctors come through, medications are provided according to their conditions. This is a normal setup that's been followed by the emergency rooms. The process icon, the data box, the inventory icon, the operator block icon, the push arrow icon, the finished goods for patient's icon, the manual information flow icon, the electronic information flow icon, and the schedule icon will all be used by us to construct the VSM of the emergency room (Kadri et al. 2023). The process symbol handles capacity issues and depicts the activity that takes place at a particular station. The information contained in the data box icon comprises the duration of a cycle, change over time, efficiency, and the total number of seconds at the station. A further overview is required for the definitions of the different data box items. Cycle time is the amount of time between a specific component or customer leaving the process and the next part or customer leaving the process. The transition from producing one good or providing one type of customer service is known as a change over time (Wee et al. 2020). The operator icon, which is displayed inside the process boxes, indicates the number of employees needed to run the process or offer services. Information on machine or server uptime, available working time for each shift (seconds) breaks, and meeting and clean-up times are required. The sections that follow deal with these topics in further detail. In an emergency department, there are a variety of possible patient flow scenarios for each family of products and services. For this reason, the most frequent flow situation is taken into account, and present value stream maps are created for each level of product/service.

Figure 1: VSM emergency room

(Source: http://image.slidesharecdn.com/12may1345deanblisstrackarev1-1324465696655-phpapp01-111221051739-phpapp01/95/lean-what-is-it-and-how-does-it-work-22-728.jpg?cb=1324445291)

Identification and analysis of the system

The purpose of this study was to find out what occurs to individuals when they move through urgent medical pathways that could lead to hospital admission. Admission decision processes for each site were mapped to accomplish this. It quickly became clear that these value stream maps were a representation of an ideal in which specific process activities occurred in a particular order. According to the observed reality, a variety of factors influenced the pathway, so processes could occur in a different order than that shown by the VSM. Additionally, depending on the patient's needs and the environment in which they arrived, additional processes could be added or removed. Consequently, rather than taking the time for a particular patient in reference to a basic value stream map, the patient paths were examined by looking at the big picture. Timing data was used to analyze time spent in the hospital (Gualano et al. 2021). To understand how long a patient has spent time in there, we need to find where the patient spends most of the time. To find out where time waste is happening in the total checkup pathway, the points are: (i) time being wasted between arriving and getting by the doctor. (ii) Waiting for the final discussion with the doctor after being checked by the doctor a while ago. (iii) Losing and wasting time while getting admitted as the time between checking and getting admitted is more than needed (Stawicki et al, 2020). The following process points—arrival, evaluation, decision, and departure—were chosen because they were completed for each individual and happened in a certain order, in contrast to other process points that happened less frequently (both in frequency and order). These process steps were selected because they happened frequently, however, in a few cases, a final choice had already been taken when an evaluation was taking place, which could have an impact on the outcomes. The final choices were made following the diagnostic tests, but generally, a working option was made at the time of assessment.

Recommended new state VSM

To minimize process variation, achieve goal values, and promote continuous improvement, it is crucial to design control policies. The following policies were suggested. (i) The employee performing a particular task should be the one with the most knowledge of that job; workers should be given a healthy workplace that encourages job ownership; and team efforts should be encouraged to innovate and change with the involvement of all the employees. When feasible, problems that are found should be corrected immediately. For communication and visibility purposes, the intended action should be recorded on the inspection sheet if an issue is not being fixed right away. (ii) It is preferable to have patients figure out the LOS performance metric, to suggest an unusual report when the objective is exceeded, and to arrange regular review meetings; to determine the LOS for patients at the department, it can make use of the hospital information system. (iii) VSM should be designed such that the whole setting from getting registered to getting discharged goes smoothly and with less cost and time efficiency of the staff (Usman et al. 2029). Critical patients are mandatory to be transferred to emergency intense care, this kind of progression and submission for every patient is required, like the hospital have the past medical detail of the patients, and they should be assigned their doctor only for better and easy understanding of current medical issues or conditions. For old patients that are already in the care of a doctor in the hospital, the visiting hours should be at such time when emergency patient flow as per statistics.

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Flow is the ultimate goal for process improvement. The patient's experience should flow easily from one phase to the next, with little wastage and no impediments. Everyone understands what to expect next, and the patient spends only as much time in the medical environment as is required to safely and efficiently treat their health issue. It takes time to reach this state. Whenever possible, establishing processes is one necessary flow (Czeisler et al. 2020). Systems like ‘Pull system' should be incorporated, whenever a process can harm or damage the total setup of a patient that step should b cut off the system.

Discussion on intended and unintended consequences of the modern system

The quality of medical treatment provided in hospitals may eventually increase thanks to emergency department information systems (EDIS), a major emphasis of both federal laws and U.S. healthcare reform. However, in their current state, EDIS poses a number of risks to patient safety and quality of care. As these systems are adopted across the nation, two physician work groups from the American College of Emergency Physicians evaluated the dangers lurking in EDIS and offered ideas on how to enhance patient safety (Koelling et al, 2020). They therefore created some recommendations, some of which were intended for the EDIS practitioner and others at the end user, for emergency departments applying any kind of EDIS, they are

• Appoint someone for specifically emergency rooms.
• Creating disciplinary comity to improve EDIS efficiency.
• Advancing the review process.
• Improving from the mistakes that happened in the ER.
• Improving all the technological parameters in the ER.

Regarding secondary outcomes for high-acuity patients who were discharged without consulting a doctor, the intervention cluster met its 10% improvement target and came close to meeting the 90% benchmark (89.1%). The intervention also met the 10% improvement criteria for low-accuracy patients who had been discharged and weren't consulted. The MDNRSTAT exceeded the ideal objective (92.1%) while the intervention fell short (83.3%). For patients who were either admitted or discharged and needed a consultation, there was no discernible difference in the intervention and the control group. Using the information acquired from the walkthrough, the session began with discussions about the overall framework and business designs of the hospital and hospital support operations. The current method was illustrated by facilitators using huge poster paper, colored markers, and a drawing pad. The VSM's symbols and format were modified to have the most meaning for the team and other organization members. After the VSM was created, it was made available to other staff members, and their suggestions were included. It is demonstrated how the VSM works as one revision among several that happened throughout the development process. The team reviewed the finished map with a group of mothers who had recently given birth at the clinic and were present for a well-baby session, despite the fact that no patients had taken part in the mapping exercise (Williamson et al. 2020). This was done to ensure that the flow depicted in the poster which had been developed properly represented their experience of the path through the ANC and delivery processes. The procedure involved the mothers collectively recalling the numerous processes and confirming that each of them was represented in the poster. The purpose of this experiment was to verify that the VSM accurately described the caregiving process, not to evaluate the mother's experience. Intended or unintended, consequences may occur proceeding with the developed plans.

Recommendations

Various recommendations can be suggested to improve or effectiveness of an active ER. Acquiring staff that are up to the mark, and can do their tasks efficiently. Loading the Software systems that will improve the quality of the workspace and be user-friendly also, less paperwork and more software analysis will be a big time saver (Nardone et al, 2020). Waiting room criteria management can always help, patients who need more medical help can be admitted soon with the help of the latest technologies that require less paperwork and relays on data, comparing all the history of the patient it will be more efficient and beneficial for the hospital. Jumping from desk to desk is more time-consuming, resolving that issue will save more time.

Conclusions

In conclusion, things may seem like not so upgraded or different from the other methodologies or applications but simple chances can pull through a lot. Minor but efficient details factor in a lot more than big changes. If an ER is not being efficient enough there is no point in the existence of the emergency room. To apply and improve the changes the management should consider seeing beyond vision as not being able to see what is unnatural or extra, then expecting a small upgrade from the system is more unnatural. A simple change in a leader can resolve most of the problems, but changing the process or looking differently into a projection is less costly and efficient.

References

Journals

• Koelling, C. P., Eitel, D., Mahapatra, S., Messner, K., & Grove, L. (2020). Value stream mapping the emergency department. Grado Department of Industrial and Systems Engineering, Virginia Tech. Blacksburg, VA. Retrieved from: https://www.iise.org/uploadedFiles/SHS/Resource_Library/details/180.pdf [Retrieved on: 1/8/2023]
• Kadri, F., Dairi, A., Harrou, F., & Sun, Y. (2023). Towards accurate prediction of patient length of stay at emergency department: A GAN-driven deep learning framework. Journal of Ambient Intelligence and Humanized Computing, 14(9), 11481-11495. Retrieved from: https://link.springer.com/article/10.1007/s12652-022-03717-z. [Retrieved on: 1/8/2023]
• Wee, L. E., Fua, T. P., Chua, Y. Y., Ho, A. F., Sim, X. Y., Conceicao, E. P., ... & Tan, B. H. (2020). Containing COVID?19 in the emergency department: the role of improved case detection and segregation of suspect cases. Academic Emergency Medicine, 27(5), 379-387. Retrieved from: https://onlinelibrary.wiley.com/doi/abs/10.1111/acem.13984. [Retrieved on: 1/8/2023]
• Gualano, M. R., Sinigaglia, T., Lo Moro, G., Rousset, S., Cremona, A., Bert, F., & Siliquini, R. (2021). The burden of burnout among healthcare professionals of intensive care units and emergency departments during the COVID-19 pandemic: a systematic review. International journal of environmental research and public health, 18(15), 8172. Retrieved from: https://www.mdpi.com/1660-4601/18/15/8172 [Retrieved on: 1/8/2023]
• Stawicki, S. P., Jeanmonod, R., Miller, A. C., Paladino, L., Gaieski, D. F., Yaffee, A. Q., ... & Garg, M. (2020). The 2019–2020 novel coronavirus (severe acute respiratory syndrome coronavirus 2) pandemic: A joint american college of academic international medicine-world academic council of emergency medicine multidisciplinary COVID-19 working group consensus paper. Journal of sglobal infectious diseases, 12(2), 47. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7384689/ [Retrieved on: 1/8/2023]
• Usman, O. A., Usman, A. A., & Ward, M. A. (2019). Comparison of SIRS, qSOFA, and NEWS for the early identification of sepsis in the Emergency Department. The American journal of emergency medicine, 37(8), 1490-1497. Retrieved from: https://www.sciencedirect.com/science/article/pii/S0735675718308891. [Retrieved on: 1/8/2023]
• Czeisler, M. É., Marynak, K., Clarke, K. E., Salah, Z., Shakya, I., Thierry, J. M., ... & Howard, M. E. (2020). Delay or avoidance of medical care because of COVID–19–related concerns—United States, June 2020. Morbidity and mortality weekly report, 69(36), 1250. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7499838/.[Retrieved on: 1/8/2023]
• Williamson, B., Eynon, R., & Potter, J. (2020). Pandemic politics, pedagogies and practices: digital technologies and distance education during the coronavirus emergency. Learning, media and technology, 45(2), 107-114. Retrieved from: https://www.tandfonline.com/doi/full/10.1080/17439884.2020.1761641. [Retrieved on: 1/8/2023]
• Nardone, A., Casey, J. A., Morello-Frosch, R., Mujahid, M., Balmes, J. R., & Thakur, N. (2020). Associations between historical residential redlining and current age-adjusted rates of emergency department visits due to asthma across eight cities in California: an ecological study. The Lancet Planetary Health, 4(1), e24-e31. Retrieved from: https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(19)30241-4/fulltext [Retrieved on: 1/8/2023]