In January 2019, the whole of the revamped Accident and Emergency (A&E) department will be up and running, although a lot still has to happen in order to make this possible. A&E is a complex department in which everybody comes in through the same door, regardless of their care needs. Whether you've hit your fingers with a hammer or suddenly experienced complications following chemotherapy, you enter the department in the same way. And the fact that this door is shared with the out-of-hours GP centre can often result in confusion and misunderstandings among patients.
Reconstruction and realization of the urgent care cluster
In the run-up to the reconstruction of the Accident and Emergency department (A&E/out-of-hours GP centre/Acute Admissions Unit), a fully-fledged Operational Excellence project was completed in 2012 and 2013. This project thoroughly examined the department both from the perspective of the employees and the perspective of the patients. What are the walking routes? Where is the stockroom? How effective are we? What is the general experience of A&E? How do we communicate? What care paths exists? What does all of this mean for the patient?
Upon completion of the project, we had identified concrete and tangible footholds for the development of the new department. We had also identified a large number of operational issues that could not be resolved by the renovation.
"Using the lean method has shown us that by examining things carefully, you boost the impact of the intervention and hence make the effects more sustainable.”Myron Braun A&E nurse/lean practitioner
Length of Stay
The Length of Stay project, set up in 2017, examines the entire length of time spend by patients at A&E in order to make the time between admission and departure as short and efficient as possible. Most patients leave A&E within three to four hours, although it can sometimes take as long as eight hours for patients to be admitted to hospital.
To investigate the factors at play, we examined bottlenecks within the three main processes: inflow (referral by GP, nursing home, ambulance, or own transport), throughflow (diagnostic phase), and outflow (going home or admission to hospital). For this purpose, we analysed a large quantity of data collected over the past ten years. This data was examined using a new and much more thorough method, identifying patterns that paint a much clearer and more accurate picture of the factors involved.
It is tempting to start thinking in terms of solutions right away. However, by taking a lean view of the situation, we ensure we hit the exact spot. In the past, quick interventions often failed to initiate the desired change.
Firstly, we examined the disciplines that make use of the A&E and compiled a top six representing 90% of the total patient visits to A&E. From these six, we selected three disciplines with similar processes to A&E. We then analysed the bottlenecks within the three main channels (inflow, throughflow, and outflow of patients) in order to minimize inefficiencies and delays and optimize efficient and effective cohesion between the different processes.
Present and future
The Length of Stay project has also given rise to a range of interesting subprojects. However, some projects are difficult to get off the ground as they are hard to fit into the A&E department's regular operations, especially now this major renovation project has almost literally turned the department on its head. Upon completion of the renovation, we expect the team will be able to resume a number of projects with renewed energy and vigour.
Accident and Emergency projects
Process and design of the new A&E layoutPassengers Project manager Elske Heeren, supported by A&E, out-of-hours GP centre, and Acute Admissions Unit staffDirections 2012-2013Journey
The goal was to design the layout of the new department from the perspective of the patients and the various A&E professionals. This was done as part of the renovation of the A&E department and the realization of an emergency cluster on the ground floor.
Reducing length of stay (LOS) for A&E patientsPassengers Parties involved: the A&E department and the disciplines of internal medicine, neurology, and pulmonary diseasesDirections initiated in 2017|Ambition to complete by 2018Journey
Identifying bottlenecks and finding solutions within the current process in order to reduce the current LOS of A&E patients.