Exploring waiting time, waste, and resources used for boarding patients in emergency department

Agus Aan Adriansyah; Nurul Jannatul Firdausi; Trisasi Lestari; Kuncoro Harto Widodo; Nikmatus Sa’adah

doi:10.15562/bmj.v12i2.4318

Exploring waiting time, waste, and resources used for boarding patients in emergency department

Agus Aan Adriansyah ,

Nurul Jannatul Firdausi ,

Trisasi Lestari ,

Kuncoro Harto Widodo ,

Nikmatus Sa’adah ,

pdf |
DOI: https://doi.org/10.15562/bmj.v12i2.4318 |
Published: 2023-06-21

Abstract

Introduction: The demand for health treatment in hospitals has arisen since the Indonesian government launched the National Health Insurance. Admission delay to medical wards (MWs), which makes patients board in the emergency department (ED), disrupts patient flow. This study aims to explore the barriers to boarding patients at the ED by identifying waiting time, waste, and resource adequacy.

Methods: A case study was conducted in the ED of RSUD by Dr. Moewardi. The subject was 45 patients with internal diseases. Collecting data by direct observation using a real-time method is described in value stream mapping. Problem-finding was sharpened by in-depth interviews with health workers and non-health workers in the ED and internal MWs.

Results: Prominent causes of patient flow disruptions depended on service in the ED and inpatient room. Disruptions of patient flow indicated by waiting time amounted to 3 hours, 3 minutes, and 52 seconds. Patients who transferred to the transition room were considered to have gone into MWs, although patients can be treated for more than 3 days due to waiting for bed availability in the inpatient room. Waiting and motion were the most frequent. Inadequate resources both in the ED and inpatient rooms made a wide impact on patient flow, which was worsened by problems with tool layout, fragmented work, and poor utilization of the hospital information management system.

Conclusion: The bottleneck in ED’s and MW's processes contributes to the degeneration of the stacked bed of boarding patients in ED. The improvements must be integrated to address the issues of waiting time, waste, and capacity. Improvements in the flow of boarding patients focus on fixing the documentation of laboratory result problems, arranging patient discharges, and optimizing the use of the hospital information system.

References

Mahendradata Y, Trisnantoro L, Shita L, Soewondo P, Marthias T, Harimurti P, et al. The Republic of Indonesia Health System Review. Vol. 7. 2017.
Huntington D, Hort K. Public hospital governance in Asia and the Pacific. Comp Ctry Stud. 2015;1(1):1–329.
Mullins PM, Pines JM. National ED crowding and hospital quality: results from the 2013 Hospital Compare data. Am J Emerg Med. 2014;32(6):634–9. doi: 10.1016/j.ajem.2014.02.008
White BA, Biddinger PD, Chang Y, Grabowski B, Carignan S, Brown DFM. Boarding inpatients in the emergency department increases discharged patient length of stay. J Emerg Med. 2013;44(1):230–5. doi: 10.1016/j.jemermed.2012.05.007
Powell ES, Khare RK, Venkatesh AK, Van Roo BD, Adams JG, Reinhardt G. The relationship between inpatient discharge timing and emergency department boarding. J Emerg Med. 2012;42(2):186–96. doi: 10.1016/j.jemermed.2010.06.028
Hodgins MJ, Moore N, Legere L. Who is sleeping in our beds? Factors predicting the ED boarding of admitted patients for more than 2 hours. J Emerg Nurs. 2011;37(3):225–30. doi: 10.1016/j.jen.2010.02.020
Hoskins R. Is it time to “Lean” in emergency care? Int Emerg Nurs. 2010;18(2):57–8. doi: 10.1016/j.ienj.2010.02.003
Dart RC. Can Lean Thinking transform American health care? Vol. 57, Annals of emergency medicine. United States; 2011. p. 279–81. doi: 10.1016/j.annemergmed.2010.11.027
Womack JP, Byrne AP, Flume OJ, Kaplan GS, Toussaint J. Going Lean in Health Care. Cambridge; 2005.
Martin LD, Rampersad SE, Low DK-W, Reed MA. Process improvement in the operating room using Toyota (Lean) methods. Colomb J Anesthesiol. 2014;42(3):220–8. doi: https://doi.org/10.1016/j.rcae.2014.05.006
Holden RJ. Lean Thinking in emergency departments: a critical review. Ann Emerg Med. 2011;57(3):265–78. doi: 10.1016/j.annemergmed.2010.08.001
Mazzocato P, Holden RJ, Brommels M, Aronsson H, Bäckman U, Elg M, et al. How does lean work in emergency care? A case study of a lean-inspired intervention at the Astrid Lindgren Children’s hospital, Stockholm, Sweden. BMC Health Serv Res. 2012;12(1):28. Available from: https://doi.org/10.1186/1472-6963-12-28
Mazzocato P, Thor J, Bäckman U, Brommels M, Carlsson J, Jonsson F, et al. Complexity complicates lean: lessons from seven emergency services. J Health Organ Manag. 2014;28(2):266–88. doi: 10.1108/JHOM-03-2013-0060
LaGanga L. Lean Service Operations: Reflections and New Directions for Capacity Expansion in Outpatient Clinics. J Oper Manag. 2011;504:303–422. doi: 10.1016/j.jom.2010.12.005
Souza L. Trends and approaches in Lean healthcare. Leadersh Heal Serv. 2009;22:121–39. doi: 10.1108/17511870910953788
Graban M. Lean Hospitals. 3rd ed. New York: CRC Press; 2012.
Dickson EW, Singh S, Cheung DS, Wyatt CC, Nugent AS. Application of lean manufacturing techniques in the Emergency Department. J Emerg Med. 2009;37(2):177–82. doi: 10.1016/j.jemermed.2007.11.108
Adriansyah AA, Setianto B, Lestari I, Ayu P, Arindis M. Incident analysis of patient safety in hospital : Based on feedback and supervision concept. Bali Med J. 2022;11(2):665–70. doi: 10.15562/bmj.v11i2.3137
Khodambashi S. Lean Analysis of an Intra-operating Management Process - Identifying Opportunities for Improvement in Health Information Systems. Procedia - Procedia Comput Sci. 2014;37(1877):309–16. Available from: http://dx.doi.org/10.1016/j.procs.2014.08.046
Buesa RJ. Adapting lean to histology laboratories. Ann Diagn Pathol. 2009;13(5):322–33. doi: https://doi.org/10.1016/j.anndiagpath.2009.06.005
Chan H, Lo S, Lee L, Lo W, Yu W, Wu Y, et al. Lean techniques for the improvement of patients’ flow in emergency department. World J Emerg Med. 2014;5(1):24–8. doi: 10.5847/wjem.j.issn.1920-8642.2014.01.004
Hall R, Belson D. Modeling Patient Flows Through the Healthcare System Chapter 1 MODELING PATIENT FLOWS THROUGH THE. 2006. 1–45 p. doi: 10.1007/978-0-387-33636-7

[1] Mahendradata Y, Trisnantoro L, Shita L, Soewondo P, Marthias T, Harimurti P, et al. The Republic of Indonesia Health System Review. Vol. 7. 2017.

[2] Huntington D, Hort K. Public hospital governance in Asia and the Pacific. Comp Ctry Stud. 2015;1(1):1–329.

[3] Mullins PM, Pines JM. National ED crowding and hospital quality: results from the 2013 Hospital Compare data. Am J Emerg Med. 2014;32(6):634–9. doi: 10.1016/j.ajem.2014.02.008

[4] White BA, Biddinger PD, Chang Y, Grabowski B, Carignan S, Brown DFM. Boarding inpatients in the emergency department increases discharged patient length of stay. J Emerg Med. 2013;44(1):230–5. doi: 10.1016/j.jemermed.2012.05.007

[5] Powell ES, Khare RK, Venkatesh AK, Van Roo BD, Adams JG, Reinhardt G. The relationship between inpatient discharge timing and emergency department boarding. J Emerg Med. 2012;42(2):186–96. doi: 10.1016/j.jemermed.2010.06.028

[6] Hodgins MJ, Moore N, Legere L. Who is sleeping in our beds? Factors predicting the ED boarding of admitted patients for more than 2 hours. J Emerg Nurs. 2011;37(3):225–30. doi: 10.1016/j.jen.2010.02.020

[7] Hoskins R. Is it time to “Lean” in emergency care? Int Emerg Nurs. 2010;18(2):57–8. doi: 10.1016/j.ienj.2010.02.003

[8] Dart RC. Can Lean Thinking transform American health care? Vol. 57, Annals of emergency medicine. United States; 2011. p. 279–81. doi: 10.1016/j.annemergmed.2010.11.027

[9] Womack JP, Byrne AP, Flume OJ, Kaplan GS, Toussaint J. Going Lean in Health Care. Cambridge; 2005.

[10] Martin LD, Rampersad SE, Low DK-W, Reed MA. Process improvement in the operating room using Toyota (Lean) methods. Colomb J Anesthesiol. 2014;42(3):220–8. doi: https://doi.org/10.1016/j.rcae.2014.05.006

[11] Holden RJ. Lean Thinking in emergency departments: a critical review. Ann Emerg Med. 2011;57(3):265–78. doi: 10.1016/j.annemergmed.2010.08.001

[12] Mazzocato P, Holden RJ, Brommels M, Aronsson H, Bäckman U, Elg M, et al. How does lean work in emergency care? A case study of a lean-inspired intervention at the Astrid Lindgren Children’s hospital, Stockholm, Sweden. BMC Health Serv Res. 2012;12(1):28. Available from: https://doi.org/10.1186/1472-6963-12-28

[13] Mazzocato P, Thor J, Bäckman U, Brommels M, Carlsson J, Jonsson F, et al. Complexity complicates lean: lessons from seven emergency services. J Health Organ Manag. 2014;28(2):266–88. doi: 10.1108/JHOM-03-2013-0060

[14] LaGanga L. Lean Service Operations: Reflections and New Directions for Capacity Expansion in Outpatient Clinics. J Oper Manag. 2011;504:303–422. doi: 10.1016/j.jom.2010.12.005

[15] Souza L. Trends and approaches in Lean healthcare. Leadersh Heal Serv. 2009;22:121–39. doi: 10.1108/17511870910953788

[16] Graban M. Lean Hospitals. 3rd ed. New York: CRC Press; 2012.

[17] Dickson EW, Singh S, Cheung DS, Wyatt CC, Nugent AS. Application of lean manufacturing techniques in the Emergency Department. J Emerg Med. 2009;37(2):177–82. doi: 10.1016/j.jemermed.2007.11.108

[18] Adriansyah AA, Setianto B, Lestari I, Ayu P, Arindis M. Incident analysis of patient safety in hospital : Based on feedback and supervision concept. Bali Med J. 2022;11(2):665–70. doi: 10.15562/bmj.v11i2.3137

[19] Khodambashi S. Lean Analysis of an Intra-operating Management Process - Identifying Opportunities for Improvement in Health Information Systems. Procedia - Procedia Comput Sci. 2014;37(1877):309–16. Available from: http://dx.doi.org/10.1016/j.procs.2014.08.046

[20] Buesa RJ. Adapting lean to histology laboratories. Ann Diagn Pathol. 2009;13(5):322–33. doi: https://doi.org/10.1016/j.anndiagpath.2009.06.005

[21] Chan H, Lo S, Lee L, Lo W, Yu W, Wu Y, et al. Lean techniques for the improvement of patients’ flow in emergency department. World J Emerg Med. 2014;5(1):24–8. doi: 10.5847/wjem.j.issn.1920-8642.2014.01.004

[22] Hall R, Belson D. Modeling Patient Flows Through the Healthcare System Chapter 1 MODELING PATIENT FLOWS THROUGH THE. 2006. 1–45 p. doi: 10.1007/978-0-387-33636-7

Exploring waiting time, waste, and resources used for boarding patients in emergency department

Abstract

References

How to Cite

Search Panel