LEAN Saves $1.25 Million in New ED Construction and Design Costs and Dramatically Improves Patient Care

While using LEAN principles saved nearly $1.25 million in construction and design costs for Avera McKennan Hospital & University Health Center's new Emergency Department, better patient care is the accomplishment staff take the most pride in. The new Avera McKennan Emergency Department opened its doors December 11, 2007.

"What patients want is to get in, get their care and get out," said Francie Miller, director of Critical Care and Emergency Services at Avera McKennan.

Since LEAN, patient satisfaction scores in the ED have soared from the 60th percentile to the 90th. Average length of stay has been trimmed about 25 minutes, to an average of one hour and 54 minutes. Because patients are in the ED for shorter times, it became possible to reduce the number of patient rooms in Avera McKennan's new ED from 24 to 20.

"The one thing I'm most proud of is how we put the patient at the center. We asked ourselves, what would be the epitome of great care?" said Bonnie Murtha, ED Resource RN. LEAN teams began by videotaping and analyzing current processes.

"You break down every second of your work day to find out where the opportunities are," said Lisa Lindgren, ED nurse manager. "The consultants helped us to think out of the box as much as we could."

A revamped triage process helped shorten patient length of stay. Before LEAN, patients were greeted by a receptionist, who then gathered registration information. Patients then waited until they were taken back to a room, where they were interviewed by a nurse, and then seen by a physician - about 45 minutes after their arrival.

Now, when they arrive at the door, patients are quickly assessed by a triage nurse. They are taken back to a patient care room where the triage process is completed within five to seven minutes. A physician is in to see the patient within 15 minutes of their arrival in the ED.

"That's truly who the patient is here to see - the physician," said Lori Deryke, ED Resource RN.

After a patient's pain has been controlled, blood has been drawn, and tests have been ordered, then a registration staff member goes to the patient's bedside to collect personal data and insurance information, during what was previously wait time for the patient.

Patient rooms, once set up for specialized procedures, now have a universal design. Supply carts are now specialized for different care needs and brought to the point of use - the patient's bedside.

"As a registered nurse who works at the bedside, it is awesome to have my fingers on anything I could possibly need to take care of that patient and not have to leave the room to run after this or that. It makes my job so much easier," Murtha said.

Before LEAN, Avera McKennan's ED already ranked in the top 5 percent to 7 percent in the nation for patient length of stay.

"I thought we did things pretty well in the first place," said Radelle Deis, ED Resource RN. "It was not until we started digging into it that we really saw there were areas for improvement."

LEAN incorporates the best possible patient care with the most efficient use of resources and staff time. "It all comes together and works for the benefit of the patient," Deis said.

One key impact of LEAN was several new patient safeguards, including arm bands imprinted with patient allergy information. That initiative was later adopted hospital-wide. Thousands of dollars were saved by streamlining inventory, and efficiencies were gained in moving equipment or instruments from one area to another.

Using LEAN principles, front-line ED staff were empowered to help design the new department. "Our new, state-of-the-art facility has technologies built into it to help us continue the LEAN process," Deis said.

While a formal LEAN team is only on the job for up to 16 weeks, LEAN never ends, and departments continue to realize benefits.

"LEAN has become such a part of our everyday work that it's just natural," Lindgren said. "We're constantly relooking at things to see how we can improve things for our patients."