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A Lean Team Transformation to Improve Patient Satisfaction

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Primary Author:</td>
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Veronica Palustra, RN, MSN&nbsp;&nbsp;</td>
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Co-Principal Investigators/Collaborators:</td>
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Lily Wu, RN, Lotta Mae Alba ,RN, Kathleen Munro RN</td>
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Organization:</td>
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El Camino Hospital</td>
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Abstract</h2>
<h3>
Purpose</h3>
<p>Length of stay (LOS) is measured when the patient arrives in the Emergency Department (ED) to the time the patient is admitted to the hospital. Increased LOS leads to higher cost to the patient, organization, and higher mortality and morbidity. The Joint Commission cites poor communication as the number one root cause of sentinel events and is greater cause of patient dissatisfaction than the actual LOS.</p>
<h3>
Background</h3>
<p>To provide a seamless transition from Emergency Department to hospital admission, an interdisciplinary team of frontline staff from ED, medical surgical, and telemetry units collaborated to define safe, timely, and efficient care to improve the patient experience.</p>
<h3>
Materials &amp; Methods</h3>
<p>Front-line staff participated in a rapid process improvement (RPI) utilizing &ldquo;Lean&rdquo; methods (from the Toyota Production System) to improve patient throughput. By holding ourselves accountable, we eliminated waste through identifying non-value-added activity (NVA) to achieve a more positive patient experience. Patients were brought to a room immediately after being triaged driven by availability. A provider and nurse met simultaneously with the patient to discuss the plan of care, improving communication while keeping the patient informed. The Interprofessional team created &ldquo;the plan of care&rdquo; form. Each patient received the name of the provider, nurse and estimated wait times for lab results and procedures.&nbsp;A standardized communication process was developed where inpatient nurses reviewed the ED patient handoff summary in the electronic medical record (EMR) and would communicate with ED nurses for questions or updates improving organization and collaboration for meaningful inpatient transfer. ED physicians and hospitalists collaborated on specific diagnosis for bridging orders and standardized the admission order set for safe and efficient throughput.</p>
<h3>
Results</h3>
<p>In 13 months, LOS decreased from 295 to 275 minutes. Our ED to inpatient goal is 280 minutes.&nbsp;</p>
<h3>
Conclusion</h3>
<p>Collaboratively, the team decided on solutions based on real time data and feedback from daily huddles. To sustain a culture of continuous improvement, transparency is vital and requires commitment from all.&nbsp;</p>
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<h3>
Bibliography</h3>
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<li>
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<p>&copy; Improvement Science Research Network, 2012</p>
<p>The ISRN&nbsp;published this as received and with permission from the author(s).</p>

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