Ongoing Transformation of the ED

The Problem

According to a study published online by Health Affairs on January 15, 2008, the median wait time before seeing a physician for all emergency department patients rose to 30 minutes in 2004, a 36 percent increase from 22 minutes in 1997. As recently as 2003, visitors to Mary Washington Hospital's ED often endured excessively long waits before seeing a physician. Roughly 14 percent found the wait intolerable and walked out before receiving treatment. As an example of just how bad the waits could be, on one particularly bad day, December 2, 2003, 44 of the 50 ED beds were taken up by patients waiting for an inpatient bed, leaving six ED beds for the 75 people in the waiting room.

The Solution

Leaders in the ED envisioned a 'No Wait ED,' by incorporating tools and concepts of operations management. Specifically, Lean methodology allowed the team to begin to view health care from the patient's perspective. Looking at operations in the ED through this lens, a multidisciplinary team turned the focus on developing strategies to eliminate waste and create patient value.

To begin the transformation of the ED, the team came together to develop a super track system for level 4 and 5 patients as defined by the Emergency Severity Index. At that time, 30 percent of the ED's 50 beds were dedicated to these low acuity patients. Looking at operations from the patient's perspective, the team readily identified opportunities to reduce the number of steps and providers involved in managing and treating these patients. The team defined a new process—one that gets patients to physicians and on the way home much more efficiently, with fewer beds and fewer staff and ultimately reducing the length of stay.

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