Case Study: Redesigning Patient Flow
rooms and beds. The sequential nature
The Challenge
Emergency Departments can be fast-paced, but
not necessarily efficient. Unsatisfied patients
often complain about long waits, or having to
repeat the same information to different people.
Although most ED staff try to treat patients as
quickly and effectively as possible, inefficient
processes can result in a chaotic situation for
both patients and staff .
Charleston Area Medical Center (CAMC) is West
Virginia’s largest medical center and a Level
1 trauma facility. Since 2003, visits to CAMC’s
General Hospital Emergency Department have
grown by 5 to 6 percent annually. This increasing
volume, along with a desire to improve patient
care and satisfaction, prompted CAMC to hold a
Lean Kaizen event to streamline the ED.
The project leader, Steve Cunningham, says his
team had a goal of starting care for all patients
within 30 minutes after arriving in the ED (an
industry standard target).
The Process
The Lean project team started by observing the
actual ED process, looking for inefficiencies.
Among the problems identified were significant
travel time for registration staff, disconnects in
communication between triage and treatment area
personnel, and under-utilization of open treatment
of the process also concerned the team.
“Our ED staff was very task oriented,
but not very process-oriented,” ad-
mits Cunningham. This resulted in a
fragmented and lengthy patient expe-
rience. Instead of singling out these
bottlenecks, the team concentrated on
the flow of the entire process. From
patient sign-in to physician orders the
average time was 99.6 minutes. But a
value stream analysis showed that only
24.8 minutes was value-added time,
leaving plenty of room for improve-
ment.
On the second day of the Kaizen
event, the team worked on the future
state design for the process. In fact,
they developed two processes—one
for treating patients during “normal”
conditions when ED beds are avail-
able, and one for busy times when all
the ED beds fill up and treatment must
be initialized in the waiting room or
triage area.
Both scenarios featured a shorter
registration system to minimize initial
paperwork and get the patient into the
system quickly. The team proposed
that the registration staff gather the
rest of the information later, at the pa-
tient’s bedside, and then use a hallway
computer to complete the process.
As Cunningham explains, there’s
something psychological about being
moved to a treatment room sooner.
Even if the patient has to wait a
bit, or provide additional informa-
tion after being moved, the patient’s
perception is that they are being taken
care of more quickly.
The project team went to the emergency
department and briefed the ED staff on the
revised procedures. The team then singled out
two patients and guided them through a “bed
available” scenario. When the ED got busier,
they selected another patient and tested a “bed
not available” scenario.
In both cases, the results were even better than
they had hoped. The observed average time
from patient sign-in to initiation of care was 6.5
minutes—a 95 percent improvement over the
baseline, and way below the project’s 30 min-
ute goal.
About BMGI
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national (BMGI) employs a global team of
seasoned business executives, master con-
sultants, subject matter experts, Lean Six
Sigma practitioners, innovation authorities
and change leaders. With operations on five
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at 1-800-467-4462.

The Results
When the hospital was ready to implement the
changes, the project team ran a second pilot
to make sure no other changes were needed.
This go round, the average time between
patient sign-in and initiation of care hovered
around 30 minutes, the team’s original goal.

After implementing the new procedures, patient

satisfaction scores have been positive, CAMC
reports. Plus, the changes move the facility
closer to one of its strategic goals—to reduce
by 50 percent the number of patients with an
ED length of stay longer than four hours.

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CAMC used BMGI’s unique Lean SCORE™

methodology to realize significant improve-
ments in the ED and throughout their facilities.