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OM in the News: How to Fix the Emergency Room Using OM Tools

September 19, 2017

Armed with new strategies borrowed from OM, The Wall Street Journal (Sept. 13, 2017) writes that “hospitals are making a push to fix one of the most irritating issues in health care: the emergency room.” Not only are wait times long, but they’re not improving. The median length of stay for patients treated in the ER and then discharged was 138 minutes in 2015-16, the same as a decade earlier. Crowded ERs and long wait times have bad effects for patient outcomes and satisfaction. I suspect that many of your students have had some ER experiences, and will have their own ideas to complement these found in the article:

Eliminate triage. One of the biggest frustrations people encounter in the ER is registration and triage. After signing in and giving information, patients see a nurse who asks questions to judge how urgently they need care and the amount they’ll need, on a 5-point scale. Then patients wait to see a doctor who may ask them the same things all over again. A patient seldom sees an MD in less than 30 minutes, even if the ER is empty.

Eliminate details that waste time using lean management. Use lean (Ch. 16) to look at all steps in the ER processes and figure out how to improve them, cutting out as much waste as possible. For example, one hospital saw nurses were taking time to escort patients to other areas of the hospital for X-rays, so it put up colored tape that patients could follow to where they needed to go.

Quickly help patients with minor complaints and those who probably just need tests. Give people with small complaints, or who need diagnostic tests their own spot in the ER–and not a bed. Redesign the ER to include an area where patients in need of a medication refill or with mild complaints can be seen right away by a professional dedicated to only such patients. Seeing low-acuity patients quickly means there’s not a huge pileup of people in the waiting area.

Classroom discussion questions:

  1. How could software help?
  2. What other stumbling blocks slow down the ER process (eg, prescheduled surgeries or admissions to the hospital, which are also mentioned in the article)?


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