1. Eastern Health: Improving ED to Ward Transfer
Lean Team Members
Michael Butler

2. Overall Process Being Mapped
After consultation with the Hospital’s Admission & Discharge Manager, the initial plan was to map the journey of a medical patient from admission to the Emergency Department to transfer to Ward 2 East. This process was selected for a number of reasons, including:
Ongoing problem of meeting our DHS HDM access target for ‘No. of Patients with LOS in ED >24 hours’, which appeared to correlate with patients requiring admission to a medical bed
The ED had previous Lean experience, including undertaking 5S and VSM – associated with ‘InformED’ funding
Low Nursing Staff morale in 2 East
Opportunity to link this with other improvement activities occurring in 2 East and to impart Lean Thinking to the nursing staff of the ward
Following completion of the current state VSM for this process, in consultation with 2E NUM & ANUM it was decided to narrow the project focus to a process related to the admission from ED to 2E, thus the following.

3. Project Aim & Plan Project aim:
Reduce bed preparation time to 30 min in Ward 2 East
(From bed vacated to next admission from ED)
Project Plan:
VSM, presentation to ward staff, consult’n with NUM, Nurses & WSS I
dentify waste / problem areas
Inefficient work areas – pan room, treatment room, work stations, etc.
Non-standardised work – nurses & WSS have varying systems of identifying & notifying one another of a bed to be cleaned / once a bed has been cleaned.
Key Stakeholders
Medical patients, 2E NUM / ANUMs / staff, Bed Mgr, ED staff, WSS staff, Hospital executive team

4. Current State Value Stream Map

5. Bed Prep Value Stream Map – Future State:

6. Kaizen Blitz Actions:
Identify ward admission takt time – Source: Trend Care
Takt time (identified using 12 months of admission data) = admissions per day
Takt time for each day of week also identified
‘Follow’ bed at different times in day
Progress –3 beds ‘followed’ & mapped during morning shifts, to be followed by mapping during pm shift
Further define p.r.n. by using ‘problem is/is not’
Collect data – bed vacated & admission to ward times
Pre-implementation data collection commenced
5S to improve efficiency in identified ward areas
Project team formed and work commenced
Ward areas identified and prioritised
Information on 5S tool provided and 5S expertise sort from ED Logistics Co-ordinator
Standardise work / roles of WSS and nursing staff in relation to bed preparation / cleaning – written guidelines
Project team formed and bed mapping completed
Issues as previously identified
Additional issues identified, including inconsistent use of Transit Lounge!

7. Next Steps: Project handed over to Ward 2 East (December 2006)
EH ED Patient Flow Committee formed, including 4 Angliss reps
Purpose - ?????
Angliss data presented so far has included:
7.3% growth in patients requiring admission to a ward from ED comparing 2005/06 with 2006/07(July to Dec)
Top 10 Diagnosis for LOS >24hrs - audit of pt records of top 3 conditions (UTI, Lobar Pneumonia and CHF) is being conducted to determine reason for delay and if alternatives means of managing pt
Time of Arrival at ED for LOS >24hrs (EH data)
Majority of pts with LOS>24hrs arrive between 1000 and 1600
Other data to 2200 there are more bed requests than separations, 1000 to 1800 there are more separations than bed requests
Day of the Week ED presentations for LOS >24hrs (EH data)
Data showed a significant increase of 24hr LOS on Sundays, with Friday at 7% and Sundays at 25%. Separations were reversed showing 8% on a Sunday and 17.3% on a Friday
Average time for ‘Available to transfer from ED to Ward’
Varied between min, sometimes waiting up to 149 min.
Plan to develop Angliss ED Patient Flow Committee,
To implement improvements based on EH ED Pt Flow findings / data
Membership to inc. IP medical beds (2E) reps
To use Lean thinking as the improvement methodology