title: Dissecting delays in trauma care using corporate lean six sigma methodology.
abstract: OBJECTIVE
  The Institute of Medicine has identified trauma center overcrowding as a crisis. We applied corporate Lean Six Sigma methodology to reduce overcrowding by quantifying patient dwell times in trauma resuscitation units (TRU) and to identify opportunities for reducing them.
  
  
  METHODS
  TRU dwell time of all patients treated at a Level I trauma center were measured prospectively during a 3-month period (n = 1,184). Delays were defined as TRU dwell time >6 hours. Using personnel trained in corporate Lean Six Sigma methodology, we created a detailed process map of patient flow through our TRU and measured time spent at each step prospectively during a 24/7 week-long time study (n = 43). Patients with TRU dwell time below the median (3 hours) were compared with those with longer dwell times to identify opportunities for improvement.
  
  
  RESULTS
  TRU delays occurred in 183 of 1,184 trauma patients (15%), and peaked on days with >15 patients or with presence of five simultaneous patients. However, 135 delays (74%) occurred on days when </=15 patients were treated. Six Sigma mapping identified four processes that were related to TRU delays. Reduction of TRU dwell time by 1 hour per patient using interventions targeting these specific processes has the potential to improve our TRU capacity to care for more patients.
  
  
  CONCLUSIONS
  Application of corporate Lean Six Sigma methodology identified opportunities for reducing dwell times in our TRU. Such endeavors are vital to maximize operational efficiency and decrease overcrowding in busy trauma centers working at capacity.
authors.affiliation: Department of Surgery, Division of Burns, Trauma and Critical Care, University of Texas Southwestern Medical School, Dallas, Texas, USA.
authors.forename: Jennifer K
authors.initials: JK
authors.lastname: Parks
authors.forename: Jorie
authors.initials: J
authors.lastname: Klein
authors.forename: Heidi L
authors.initials: HL
authors.lastname: Frankel
authors.forename: Randall S
authors.initials: RS
authors.lastname: Friese
authors.forename: Shahid
authors.initials: S
authors.lastname: Shafi
mesh_terms: D017598:Efficiency, Organizational; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay; D010043:Outcome and Process Assessment, Health Care; D005791:Patient Care; D017064:Process Assessment, Health Care; D013997:Time Factors; D017749:Total Quality Management; D014193:Trauma Centers / Q000706:statistics & numerical data*; D014505:Urban Population; D014947:Wounds and Injuries / Q000628:therapy*