Erum Gonsalves
Aga Khan University, Pakistan
Title: Towards a lean emergency department: Redesigning processes to meet rising demand
Biography
Biography: Erum Gonsalves
Abstract
Situated in the densely populated metropolis of Karachi, the Emergency Department(ED) at The Aga Khan University Hospital is arguably one of the most complex clinical settings, catering to the highest acuity patients. Inefficient processes in the ED delayed key activities resulting in a high average LOS of 10.3 hours for admitted patients, and 3.25 hours for discharged patients (2017). Consequently, the number of times an ED bed could be turned over in 24 hours went as low as 4 restricting ED bed supply. Hence in 2017: 4,741 patients left ED because of unavailability of bed (LBUEB) leading to a potential revenue loss of $2.8 million to the hospital.
A thorough data analysis and time and motion study by the Business Process Reengineering (BPR) team revealed that wastages in the existing processes prolonged decision and transfer times to 4.75hours and 1.8hours respectively. To achieve faster throughput, it was imperative that clinical decisions were accelerated, staff roles were reorganized and manual activities were eliminated from work flows.
The project aimed to achieve a ‘leaner ED’ by aligning existing systems to meet user requirements, automating the bed tracking and standardizing the patient transfer process (SBAR). Furthermore, inter-disciplinary communication within ED staff was improved by introducing nursing team-leads in each area and a non-clinical shift-lead to expedite operational activities and reinforce smoother communication between ED and Inpatient Area.
As a result, length of stay reduced by 1.7hours for an admitted patient and 0.25hours for a discharged patient. Subsequently, overcrowding reduced: 84% of P1 patients were assigned an ED bed within 10mins of Triage and LBUEB reduced by 44%.
Sustaining these results will potentially yield 50,200 additional ED bed hours annually. Capitalizing on 75% of these hours ED can potentially admit 20 more patients per day, earning the hospital an annual revenue of $4.1million.