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Benchmark for ED Turnaround Time

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  • #25285

    ahmed
    Participant

    Hello,
    I am working on a Six Sigma project on Emergency Dept. turnaround time. I am looking for benchmark for this area.Could anyone please help if you have any idea?
    Any thought will be appreciated.Amy

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    #60829

    Jeff
    Participant

    Good morning –
    What kind of patient volume does your ED see in a year? What type of ED (Level I, II, or III trauma)? How many beds?
    All of these are factors that have to be considered…national benchmarks are vague at best, with 3 to 4 hours TAT as a “standard”, but that is for an ED that sees 40,000 patients a year and is not a Level III trauma center.
    VOC is a tough thing in this type of project, because patients will tell you that they want to be seen immediately and never be there more than a couple of hours, but then, when I need an ED, I feel the same way…you may want to look at an entitlement calculation for your ED’s past performance, and then determine if that is a good target to attempt to stabilize on…
    Most ED’s benefit more from Lean events in the early stages of a TAT reduction project, because the large number of X’s involved in each and every patient encounter make a true DMAIC project difficult to manage unless your scope is extremely tight.
    Good luck!

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    #60830

    ahmed
    Participant

    Thanks for your message, Jeff.
    It is a level II trauma. Our pt volume for the past year was around 55,000, 450 beds.
    I agree that lean will help a lot in this project, VSM, data collection, etc.
    Thanks again.
    Amy

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    #60831

    Jeff
    Participant

    My first project was in a Level II center which saw 121,000 patients through the ED last year…approximately 40 ED beds supporting a 600 bed hospital…after we hit Analyze, we realized that the scope was too broad and the project was broken down into a series of 10-12 Lean events that are ongoing…when they are completed, we may attempt to go back in and look at another DMAIC project for this area, but we now know it is a “boiling the ocean” scenario without a better scoping process…

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    #60832

    ahmed
    Participant

    Jeff,
    Thanks for your message.
    At the beginning, I tried my efforts to focus the team on the scope — pt arrives ==> pt physicially leaves ED. pt physicially leaves ED. pt physicially leaves ED.Several depts are involved in the process. We are separating the big project into sub-projects. Or it is going to be very hard to faciliate.Thanks again and best regards.

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    #60835

    Brit
    Participant

    We measure three baselines – ED Discharge LOS, ED Admit LOS and our fast track LOS.  Our current measures are:

    ED Discharge LOS:  2.37 hrs
    ED Admit LOS: 3.45 hrs
    Fast track LOS (not really a fast track): 3.12 hrs
    We are a 55,000/yr ED.
    Some advice on ED improvement:  Most of the up front efforts like registration, triage in the ED, Lab turnaround, etc. are less of an effect on TAT than discharging patients faster from the “main” hospital.  One good effort that we put in place (in addition to ED improvements) was creating a discharge area, utilizing hospitalists to assist in discharging, and improving the transportation – inside and outside of the hospital.  Each of the measures above were at least an hour longer this time last year.

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    #60841

    Lewis Brown
    Participant

    Amy,
    We spent 6 months in the ED working on TATs. We have a 30 bed facility that sees 36000 pt’s a year. We could not find any bench marks, so we took our average as a baseline, and the entitlement as a goal. In an attempt to scope down, we identified 2 pt groups, Admit patients, and NonAdmit patients. Our study focused on the NonAdmits. Scoping your project down into smaller projects is definately the way to go. We got our times down to 3.0 hours for the NonAdmits.
    Lewis

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    #60844

    ahmed
    Participant

    Thanks for your advice, Lewis.
    Yes, it is a huge project. It is reasonable to break it down to sub-projects.
    Thanks again.
    Amy

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    #60845

    Ram
    Participant

    Amy,
    As it has already been suggested breaking down the whole thing it sub projects would be a first phase to start your project with.
    But some of the Benchmarks I would consider taking a look at is:
    1. Traige assessment-best practices call for 2-5 minutes so it is always a good start to fix your front end, this part can be one of the sub-projects. But at the same leveraging the rear/back end i.e. physicians to see the patients fast would be a great patient satisfaction driver.
    2. An 85% guarantee from all the ancillary services to be sure on thier Turn around time wth respect to the services requested would be another step you might want to look at. Like labs, xray,CT etc.
    3. Admissions to the hospital or bed allottment and also moving the patient from ED to the concerned floor would be another factor you might not want to miss on. Best practices with respect to inpatient bed claim 15 minutes will be a good time for a in patient bed, but there are some hospitals which claim a pateint is allotted a bed 90% of the time within  5 minutes of the request.
    I hope this information would be helpful for you.
    And some other benchmarks if you want to work with would be like a patient would be seen with in 15minutes of patient’s arrival a major patient satisfaction contributor.
    I would be glad to follow up with you if you come up with any other info.
    Ramesh!

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    #60846

    ahmed
    Participant

    Thank you, Ram. I really appreciate it.
    I am working on the d/c part, which is considered to be a huge bottleneck here. Very interesting.
    Best,
    Amy

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    #60851

    Connie
    Participant

    We are just beginning our Lean Six Sigma for the ED.  We are a non-trauma center with 2 ED’s and 2 Prompt Care (1 is part of one of the ED’s and the other free standing).  The ED that has the Prompt Care sees a combined 60 K per year.  This seems to be the spot where the difficulties are the most apparent.  As we begin defining, we too, have decided that we need to break the project into doable bites.
    Our physicians seem to have an inordinate number of extenders (personal observation).  This seems to bog the system down.  Does anyone have experience with having extenders – we have externs, NP’s and PA’s all at the same time.  I am use to externs but when you mix the extenders in it seems to make things muddy.  Any insight would be welcome.
    Thanks 

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