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Emergency Department Diversions

By Staff Writers

According to Daniel L. Gee MD MBA, Scottsdale Healthcare in Arizona used consultants from Creative Healthcare USA on a recent project, rather than doing a full deployment of Six Sigma in its organization, to analyze its problem of emergency department (ED) “diversions.”

Emergency Department Diversions

Diversions happen when emergency departments are too full in capacity to handle acute emergencies and a decision is made to close its doors to patients and ambulances are diverted elsewhere. The issue of closed and diverted emergency rooms is a growing nationwide phenomenon because of fewer EDs and a growing aged and uninsured population. The consultants, using Six Sigma principles, mapped the ED process and found multiple bottlenecks that have a direct effect on the probability of evoking a “diversionary” status in the emergency room.

Out of Control Bottlenecks

One bottleneck process deemed “out of control,” in Six Sigma jargon, was the issue of bed control. A process is considered “in control” when operating within acceptable specification limits. It was found that the average transfer time for a patient admitted to a hospital bed from the emergency department was 80 minutes, of which half of this time, a bed is available and waiting. The process was a significant “waste of time” and, moreover, complicated by an Administrative Nurse “inspector” locating beds on different floors.

Sig Sigma Tenants

Two tenements of Six Sigma level of quality were violated: one is that having an inspection is a correction for an inefficient process and two, the more steps involved the less is the potential yield of a process. Through this revelation, the hospital eliminated the Administrative Nurse, reduced cycle time by 10% in bed control, and improvement ED throughput with greater turnover thereby, improving revenue by nearly $600,000.

Little’s Law

The addition of a nurse inspector and waiting patients in a busy ED is an example of “Little’s Law” or sometimes referred to as the first fundamental law of system behavior. When more and more inputs are put into a system, such as more ED patients and an additional nurse employee, and when there is variation in their arrival time (no control over patient arrivals) or process variation (different people doing the same things differently), there becomes an exponential rise in “cycle time.” Productivity of the system begins to fall and inefficiency and variation creeps in.

Assessment

An examination of the project types to which health care provider organizations have utilized Six Sigma methodology reveals almost any hospital or medical clinic process is a candidate.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Is Six Sigma a real medical quality control initiative that’s here to stay; or just another passing fad?

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Filed under: Quality Initiatives, Research & Development, Uncategorized | Tagged: Creative Healthcare USA, Daniel Gee MD, ED, emergency department, emergency room, ER, health quality, medical quality, medical quality improvement, Six Sigma | 10 Comments »