32: A Lean-Based Process Redesign: Resource Utilization In the SPEED Trial

Abstract

BackgroundLean principles have been used in manufacturing processes for many years and have been associated with improved quality and success. Recently Lean principles have been applied to health care and, in particular, emergency departments (ED) to identify waste, inefficiencies and over-processing. Health care has adopted these processes to improve operations, increase efficiency and reduce waste. We used a Lean-based Synchronized Provider Evaluation and Efficient Disposition (SPEED) process to evaluate resource utilization.Study ObjectivesTo evaluate resource utilization in a targeted Emergency Severity Index (ESI)-3 patient population at a large, academic ED center with annual census in excess of 100K.MethodsA prospective study using weekly rapid cycle tests (RCT's) was conducted from January through November 2009. Applying the SPEED process, a synchronized provider evaluation, treatment and disposition process was implemented. Utilization of laboratory, radiographic and consultant resources was analyzed. Results were collected in real time for 305 ESI-3 SPEED patients and compared to a control group of 294 SPEED eligible ESI-3 patients when SPEED process was not operational. Statistical analysis was performed using Pearson's chi-square test.ResultsSee TableTabled 1The application of Lean health care principles through the SPEED redesign process resulted in fewer laboratory tests and CT scans. On the other hand, there was an increase in the number of consultants in SPEED. No significant differences were noted with respect to plain X-ray and ultrasonography utilization.ConclusionAlthough SPEED process appears to decrease some utilization of resources, this may be offset by an increase in other areas. Larger studies will need to be undertaken to further explore these variables. BackgroundLean principles have been used in manufacturing processes for many years and have been associated with improved quality and success. Recently Lean principles have been applied to health care and, in particular, emergency departments (ED) to identify waste, inefficiencies and over-processing. Health care has adopted these processes to improve operations, increase efficiency and reduce waste. We used a Lean-based Synchronized Provider Evaluation and Efficient Disposition (SPEED) process to evaluate resource utilization. Lean principles have been used in manufacturing processes for many years and have been associated with improved quality and success. Recently Lean principles have been applied to health care and, in particular, emergency departments (ED) to identify waste, inefficiencies and over-processing. Health care has adopted these processes to improve operations, increase efficiency and reduce waste. We used a Lean-based Synchronized Provider Evaluation and Efficient Disposition (SPEED) process to evaluate resource utilization. Study ObjectivesTo evaluate resource utilization in a targeted Emergency Severity Index (ESI)-3 patient population at a large, academic ED center with annual census in excess of 100K. To evaluate resource utilization in a targeted Emergency Severity Index (ESI)-3 patient population at a large, academic ED center with annual census in excess of 100K. MethodsA prospective study using weekly rapid cycle tests (RCT's) was conducted from January through November 2009. Applying the SPEED process, a synchronized provider evaluation, treatment and disposition process was implemented. Utilization of laboratory, radiographic and consultant resources was analyzed. Results were collected in real time for 305 ESI-3 SPEED patients and compared to a control group of 294 SPEED eligible ESI-3 patients when SPEED process was not operational. Statistical analysis was performed using Pearson's chi-square test. A prospective study using weekly rapid cycle tests (RCT's) was conducted from January through November 2009. Applying the SPEED process, a synchronized provider evaluation, treatment and disposition process was implemented. Utilization of laboratory, radiographic and consultant resources was analyzed. Results were collected in real time for 305 ESI-3 SPEED patients and compared to a control group of 294 SPEED eligible ESI-3 patients when SPEED process was not operational. Statistical analysis was performed using Pearson's chi-square test. ResultsSee TableTabled 1The application of Lean health care principles through the SPEED redesign process resulted in fewer laboratory tests and CT scans. On the other hand, there was an increase in the number of consultants in SPEED. No significant differences were noted with respect to plain X-ray and ultrasonography utilization. See Table The application of Lean health care principles through the SPEED redesign process resulted in fewer laboratory tests and CT scans. On the other hand, there was an increase in the number of consultants in SPEED. No significant differences were noted with respect to plain X-ray and ultrasonography utilization. ConclusionAlthough SPEED process appears to decrease some utilization of resources, this may be offset by an increase in other areas. Larger studies will need to be undertaken to further explore these variables. Although SPEED process appears to decrease some utilization of resources, this may be offset by an increase in other areas. Larger studies will need to be undertaken to further explore these variables.