Department of Systems Engineering, College of Engineering, Technology, and Computer Science, Purdue University Fort Wayne, 2101 East Coliseum Boulevard, Room 229 B, Fort Wayne, IN, 46805-1499, USA.
Department of Business Transformation, Franciscan Health Indianapolis, 8111 S Emerson Ave, Indianapolis, IN, 46237, USA.
J Med Syst. 2018 Oct 18;42(12):242. doi: 10.1007/s10916-018-1102-7.
Emergency Room (ER) crowding is one of the more complex issues in the healthcare system worldwide. Crowding gives rise to long ER waiting times, patient dissatisfaction, and negative effects on a healthcare systems' performance. This paper focuses on the utilization of the Collective System Design (CSD) methodology to optimize the performance of an ER, which is of principal importance both from a life-threatening and an economic standpoint. The CSD technique is applied to detect areas of deficiency and to identify the functional requirements of the system to address those issues. The ER and system engineering specialists' team gathered data from the electronic medical center log and their system observation. The team determined the functional requirements and effective solutions, and implemented a continuous improvement plan to enhance ER performance. From a statistical standpoint, a significant decrease in the median of the door-to-doctor time measure (27 min vs 13 min) and a substantial improvement in the patients' level of satisfaction with the quality of health care (20th percentile vs 41th percentile) were observed after the implementation of the CSD methodology. The CSD methodology augments the implementation of lean tools by providing a language for defining the requirements and corresponding solutions for a system design. Using the CSD methodology, results in a significant increase in the ER's capacity to treat patients efficiently.
急诊科（ER）拥挤是全球医疗保健系统中较为复杂的问题之一。拥挤导致 ER 等待时间延长、患者不满，对医疗保健系统的绩效产生负面影响。本文重点介绍了利用集体系统设计（CSD）方法来优化急诊科的性能，这从危及生命和经济角度来看都是至关重要的。CSD 技术用于发现缺陷领域，并确定系统的功能需求以解决这些问题。急诊科和系统工程专家团队从电子医疗中心日志和系统观察中收集数据。团队确定了功能需求和有效解决方案，并实施了持续改进计划以提高急诊科的绩效。从统计学角度来看，在实施 CSD 方法后，门到医生时间测量的中位数显著降低（27 分钟至 13 分钟），患者对医疗保健质量的满意度也大幅提高（第 20 百分位至第 41 百分位）。CSD 方法通过提供定义系统设计需求和相应解决方案的语言，增强了精益工具的实施。使用 CSD 方法，急诊科有效治疗患者的能力显著提高。
