Reducing Length of Stay in the Emergency Department

Completed

• Conditions: Length of Stay
• Interventions: Behavioral: Quality improvement (QI) interventions

• Registration Number: NCT03185533
• Lead Sponsor: National Taiwan University Hospital Hsin-Chu Branch

Brief Summary

Emergency department (ED) crowding has become an international challenge in the recent decades.

Length of stay (LOS) is a useful marker to monitor ED crowding. Searching for the possible causes and reducing barriers may have the greatest impact on EDLOS.

Therefore, the investigators assembled a multidisciplinary team for improvement of the ED process, to undergo assessments of ED patient flow with the spirit of lean-sigma methodologies. The objectives of this study were to evaluate a Lean-sigma-based initiative to lessen EDLOS.

Detailed Description

Lean aims to smooth out the workflow and to eliminate wastes. In the ED settings, lean principles can display the process of the ED patient flow. Six sigma, a complementary strategy, has the merit to compensate the potential weakness of Lean through a data-driven process. Currently, a combination of Lean and Six sigma methodologies develops to solve the problems of workflow.

It became clear that concurrent multifaceted interventions were needed to reduce EDLOS. Therefore, the investigators assembled a multidisciplinary quality improvement team for improvement of the ED process, to undergo assessments of ED patient flow with the spirit of lean-sigma methodologies. The objectives of this study were to evaluate a Lean-sigma-based initiative to lessen EDLOS.

Study Timeline

• Study Start: 2015-01-01
• Primary Completion: 2015-12-31
• Study Completion: 2015-12-31
• Status Verified: 2017-06
• Study First Submitted: 2017-06-04
• Study First Submitted QC: 2017-06-10
• Last Update Submitted: 2017-06-10
• Study First Posted: 2017-06-14
• Last Update Posted: 2017-06-14

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 72000

Inclusion Criteria

• the patients were registered in the ED from Jan, 2015 to Dec, 2015.

Exclusion Criteria

• the patients were excluded because of left without seeing a physician.

Study & Design

• Study Type: OBSERVATIONAL
• Study Design: Not specified

Arm && Interventions

Group	Intervention	Description
to reduce ED length of stay	Quality improvement (QI) interventions	to reduce ED length of stay to lessen ED crowding by using Lean-sigma management and quality improvement interventions including reducing boarding time and medical decision time.

Primary Outcome Measures

Name	Time	Method
length of stay for ED admissions.	12 months	Length of stay was defined as the time from patient registration to leaving the ED.

Secondary Outcome Measures

Name	Time	Method
boarding time for ED admissions	12months	Boarding time was defined as the time from decision for admission to leaving the ED.
decision time for ED admissions	12 months	Decision time was defined as the time from patient registration to decision for disposition.
the percentage of LOS over 24 hours in all ED patients.	12 months	The percentage was defined as patients staying at the ED over 24 hours/total ED visits.