Using Virtual Discrete Event Simulation and Lean Six Sigma to Reduce Door-to-Provider Time in a Tertiary Emergency Department

The emergency department (ED) was experiencing an increase in door-to-doctor times due to high patient volume. Increased wait time negatively impacted care in the areas of patient throughput, costs and patient satisfaction. The issue also impacted four of the five organizational goals, specifically those related to patient, staff and physician satisfaction and financial stewardship. ED physicians and leadership formulated changes to the ED pod structure that would decrease throughput time and provide better care and a better experience for the patient.

The emergency department (ED) was experiencing an increase in door-to-doctor times due to high patient volume. Increased wait time negatively impacted care in the areas of patient throughput, costs and patient satisfaction. The issue also impacted four of the five organizational goals, specifically those related to patient, staff and physician satisfaction and financial stewardship. ED physicians and leadership formulated changes to the ED pod structure that would decrease throughput time and provide better care and a better experience for the patient.

A computer simulation analysis predicted: a decrease in door-to-doctor time; a decrease in patients leaving without being seen; an increase in the number of patients the department could effectively handle on a daily basis; and a decrease in length of stay for patients. These predictions were proven accurate when the new process was deployed. All staffing changes were reallocations, which avoided additional staffing and helped to control the costs of adding a high-acuity pod in the ED.

This case study is part of the Illinois Health and Hospital Association's annual Quality Excellence Achievement Awards. Each year, IHA recognizes and celebrates the achievements of Illinois hospitals and health systems in continually improving and transforming health care in the state. These organizations are improving health by striving to achieve the Triple Aim—improving the patient experience of care (including quality and satisfaction), improving the health of populations, and reducing the per capita cost of health care—and the Institute of Medicine's six aims for improvement—safe, effective, patient centered, timely, efficient, and equitable. To learn more, visit https://www.ihaqualityawards.org/javascript-ui/IHAQualityAward/

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