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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Evaluation of an emergency department lean process improvement program to reduce length of stay
Annals of Emergency Medicine, Volume 64, No. 5, Year 2014
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Description
Study objective In recent years, lean principles have been applied to improve wait times in the emergency department (ED). In 2009, an ED process improvement program based on lean methods was introduced in Ontario as part of a broad strategy to reduce ED length of stay and improve patient flow. This study seeks to determine the effect of this program on ED wait times and quality of care.; Methods We conducted a retrospective cohort study of all ED visits at program and control sites during 3 program waves from April 1, 2007, to June 30, 2011, in Ontario, Canada. Time series analyses of outcomes before and after the program and difference-in-differences analyses comparing changes in program sites with control sites were conducted.; Results In before-after models among program sites alone, 90th percentile ED length of stay did not change in wave 1 (-14 minutes [95% confidence interval {CI} -47 to 20]) but decreased after wave 2 (-87 [95% CI -108 to -66]) and wave 3 (-33 [95% CI -50 to -17]); median ED length of stay decreased after wave 1 (-18 [95% CI -24 to -12]), wave 2 (-23 [95% CI -27 to -19]), and wave 3 (-15 [95% CI -18 to -12]). In all waves, decreases were observed in time to physician assessment, left-without-being-seen rates, and 72-hour ED revisit rates. In the difference-in-difference models, in which changes in program sites were compared with controls, the program was associated with no change in 90th percentile ED length of stay in wave 2 (17 [95% CI -0.2 to 33]) and increases in wave 1 (23 [95% CI 0.9 to 45]) and wave 3 (31 [95% CI 10 to 51]), modest reductions in median ED length of stay in waves 2 and 3 alone, and a decrease in time to physician assessment in wave 3 alone.; Conclusion Although the program reduced ED waiting times, it appeared that its benefits were diminished or disappeared when compared with that of control sites, which were exposed to system-wide initiatives such as public reporting and pay for performance. This study suggests that further evaluation of the effectiveness of lean methods in the ED is warranted before widespread implementation. © 2014 American College of Emergency Physicians.
Authors & Co-Authors
Rowe, Brian H.
Canada, Edmonton
University of Alberta
Zwarenstein, Merrick F.
Canada, London
Western University
Bell, Robert S.
Canada, Toronto
University Health Network University of Toronto
Schull, Michael John
Canada, Toronto
Institute for Clinical Evaluative Sciences
Canada, Toronto
University of Toronto
Canada, Toronto
Sunnybrook Health Sciences Centre
Statistics
Citations: 55
Authors: 4
Affiliations: 8
Identifiers
Doi:
10.1016/j.annemergmed.2014.06.007
ISSN:
01960644
Research Areas
Health System And Policy
Study Design
Cohort Study
Study Approach
Quantitative