Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut, Lebanon.
American University of Beirut Medical Center, Beirut, Lebanon.
BMC Health Serv Res. 2017 Sep 5;17(1):625. doi: 10.1186/s12913-017-2488-5.
Emergency Department overcrowding has become a global problem and a growing safety and quality concern. Radiology and laboratory turnaround time, ED boarding and increased ED visits are some of the factors that contribute to ED overcrowding. Lean methods have been used in the ED to address multiple flow challenges from improving door-to-doctor time to reducing length of stay. The objective of this study is to determine the effectiveness of using Lean management methods on improving Emergency Department transportation times for plain radiography.
We performed a before and after study at an academic urban Emergency Department with 49,000 annual visits after implementing a Lean driven intervention. The primary outcome was mean radiology transportation turnaround time (TAT). Secondary outcomes included overall study turnaround time from order processing to preliminary report time as well as ED length of stay. All ED patients undergoing plain radiography 6 months pre-intervention were compared to all ED patients undergoing plain radiography 6 months post-intervention after a 1 month washout period.
Post intervention there was a statistically significant decrease in the mean transportation TAT (mean ± SD: 9.87 min ± 15.05 versus 22.89 min ± 22.05, respectively, p-value <0.0001). In addition, it was found that 71.6% of patients in the post-intervention had transportation TAT ≤ 10 min, as compared to 32.3% in the pre-intervention period, p-value <0.0001, with narrower interquartile ranges in the post-intervention period. Similarly, the "study processing to preliminary report time" and the length of stay were lower in the post-intervention as compared to the pre-intervention, (52.50 min ± 35.43 versus 54.04 min ± 34.72, p-value = 0.02 and 3.65 h ± 5.17 versus 4.57 h ± 10.43, p < 0.0001, respectively), in spite of an increase in the time it took to elease a preliminary report in the post-intervention period.
Using Lean change management techniques can be effective in reducing transportation time to plain radiography in the Emergency Department as well as improving process reliability.
急诊部门拥挤已成为全球性问题，也是日益严重的安全和质量隐患。放射科和检验科周转时间、急诊留观床位增加和急诊就诊人次增加等因素都会导致急诊拥挤。精益方法已被用于急诊，以解决从缩短门到医生的时间到缩短住院时间等多个流程挑战。本研究的目的是确定使用精益管理方法改善急诊平片放射科运输时间的效果。
我们在一家拥有 49000 名年就诊人次的学术型城市急诊进行了一项前后对照研究，在实施精益驱动干预后进行。主要结果是平均放射科运输周转时间（TAT）。次要结果包括从医嘱处理到初步报告时间的总研究周转时间以及急诊停留时间。在 1 个月洗脱期后，将 6 个月前干预的所有急诊行平片检查的患者与 6 个月后干预的所有急诊行平片检查的患者进行比较。
干预后，平均运输 TAT 有统计学显著降低（平均±标准差：9.87 分钟±15.05 与 22.89 分钟±22.05，p 值<0.0001）。此外，发现干预后 71.6%的患者的运输 TAT≤10 分钟，而干预前为 32.3%，p 值<0.0001，干预后 TAT 的四分位间距更窄。同样，与干预前相比，干预后“研究处理到初步报告时间”和住院时间更低，（52.50 分钟±35.43 与 54.04 分钟±34.72，p 值=0.02；3.65 小时±5.17 与 4.57 小时±10.43，p<0.0001），尽管干预后发布初步报告的时间延长。
使用精益变更管理技术可以有效缩短急诊平片放射科的运输时间，并提高流程可靠性。
