Decreasing Door-to-Floor Emergency Department Length of Stay through Applied Lean Principles

Reducing emergency department (ED) Door-to-Floor Length of Stay times for admitted patients is a high priority for most EDs. Door-to-Floor Length of Stay times can be delayed for a multitude of reasons, ranging from practice variations among personnel and a lack of open, clean, and staffed beds to high patient volume in the ED. However, there are a variety of ways to reduce Door-to-Floor length of stay metrics, including optimizing the way resources are used and standardizing workflows.

In 2019, Jessica Hughes, MD, ED Aligned Providers Wyoming President reviewed research on this very topic published in the British Journal of Medicine.

The study, 25 Applied Lean Principles Decreased Door-to-Floor Length of Stay, focused on three points: optimizing processes throughout the door-to-floor value stream by observing patients, operations, and provider processes; shadowing frontline staff to identify opportunities for process improvement; and holding rapid process improvement workshops with front line staff.

During the study, Dr. Hughes and her fellow researchers identified short-term areas for improvement and longer term improvement projects which included Plan-Do-Study-Act (PDSA) cycles and optimizing discharge time, floor placement, the patient pull system, and standardizing the ED Handoff Report.

These efforts resulted in:

  • A sustainable reduction in LOS for admitted patients from 310 minutes to 251 minutes
  • A 40% increase patients being discharged within the effective time of <5 minutes
  • Decreased bed-requested to bed-assigned times from 37 to 13 minutes by implementing a Microsoft OneNote pull system for charge nurses that helped standardize the way nurses matched patient types to appropriate units.
  • Improved quality and consistency of patient information transfer due to a standardized ED handoff report for care transitions.

If these identified improvement projects are implemented into more EDs, the average door-to-floor length of stay time across the country could see similar metric improvements, which will benefit patient experience, care quality, and ED efficiency.