Hussein Azza Hassan Mohamed, Abou Hashish Ebtsam Aly Omer, Abd-Elghaffar Basmaa Ahmed, Elliethey Nancy Sabry Hassan
Nursing Administration & Healthcare Management, Nursing Administration Department, Faculty of Nursing, Alexandria University, Alexandria, Egypt.
College of Nursing, King Saud bin Abdul-Aziz University for Health Sciences, Jeddah, Saudi Arabia.
BMC Nurs. 2025 Apr 22;24(1):445. doi: 10.1186/s12912-025-02759-w.
In emergency departments (EDs), long wait times and overcrowding are major challenges, worsened by the pandemic's increased patient volumes and demands. Lean methodology could offer a structured approach to reduce inefficiencies, improve care quality, and support nursing staff.
This study aims to evaluate the impact of applying a Lean approach to optimize emergency nursing care post-pandemic within an ER setting.
This study utilized a mixed-methods design in the ER of a private hospital in Egypt. Data collection involved three Lean tools: the voice of the process observation sheet, which tracked the journeys of 100 patients; voice of customer structured interviews, conducted with 90 patients to assess satisfaction with waiting times; and voice of business interviews, held with 64 staff members to evaluate satisfaction with available resources. Additionally, a cause-and-effect analysis was conducted and summarized in an A3 report, identifying key factors contributing to extended wait times.
The average wait time in the emergency department was 157.87 min, making up 77.7% of the total length of stay. The consultation phase accounted for the longest delays, with an average wait of 92.46 min. Patient satisfaction with waiting times was moderate (61.74%), while staff satisfaction with resources was higher (71.09%), but only 53.1% were satisfied with patient wait times. Key causes of delays included non-compliance with triage protocols (95.0%), lack of care pathways (90.3%), and insufficient bed capacity (83.1%). An A3 report proposed strategies to reduce wait times and enhance satisfaction.
This study highlights waiting times as a major challenge in EDs, significantly impacting service quality, patient outcomes, and nursing staff workload. Lean-based strategies, such as standardized triage and improved care pathways, are essential to reducing delays and enhancing both patient care and staff satisfaction in the post-pandemic healthcare environment.
在急诊科，长时间等待和过度拥挤是主要挑战，而疫情导致患者数量和需求增加，使这些问题更加恶化。精益方法可以提供一种结构化方法，以减少低效率、提高护理质量并支持护理人员。
本研究旨在评估在急诊室环境中应用精益方法优化疫情后急诊护理的影响。
本研究在埃及一家私立医院的急诊科采用了混合方法设计。数据收集涉及三种精益工具：流程之声观察表，跟踪了100名患者的就医过程；顾客之声结构化访谈，对90名患者进行访谈以评估对等待时间的满意度；业务之声访谈，与64名工作人员进行访谈以评估对可用资源的满意度。此外，进行了因果分析并总结在一份A3报告中，确定了导致等待时间延长的关键因素。
急诊科的平均等待时间为157.87分钟，占总住院时间的77.7%。会诊阶段的延误时间最长，平均等待时间为92.46分钟。患者对等待时间的满意度为中等（61.74%），而工作人员对资源的满意度较高（71.09%），但只有53.1%的人对患者等待时间感到满意。延误的主要原因包括不遵守分诊协议（95.0%）、缺乏护理路径（90.3%）和床位不足（83.1%）。一份A3报告提出了减少等待时间和提高满意度的策略。
本研究强调等待时间是急诊科的一项主要挑战，对服务质量、患者预后和护理人员工作量有重大影响。基于精益的策略，如标准化分诊和改进护理路径，对于在疫情后医疗环境中减少延误、提高患者护理和工作人员满意度至关重要。
