title: Applying the Lean principles of the Toyota Production System to reduce wait times in the emergency department.
abstract: OBJECTIVE
  In recognition of patient wait times, and deteriorating patient and staff satisfaction, we set out to improve these measures in our emergency department (ED) without adding any new funding or beds.
  
  
  METHODS
  In 2005 all staff in the ED at Hôtel-Dieu Grace Hospital began a transformation, employing Toyota Lean manufacturing principles to improve ED wait times and quality of care. Lean techniques such as value-stream mapping, just-in-time delivery techniques, workplace organization, reduction of systemic wastes, use of the worker as the source of quality improvement and ongoing refinement of our process steps formed the basis of our project.
  
  
  RESULTS
  Our ED has achieved major improvements in departmental flow without adding any additional ED or inpatient beds. The mean registration to physician time has decreased from 111 minutes to 78 minutes. The number of patients who left without being seen has decreased from 7.1% to 4.3%. The length of stay (LOS) for discharged patients has decreased from a mean of 3.6 to 2.8 hours, with the largest decrease seen in our patients triaged at levels 4 or 5 using the Canadian Emergency Department Triage and Acuity Scale. We noted an improvement in ED patient satisfaction scores following the implementation of Lean principles.
  
  
  CONCLUSIONS
  Lean manufacturing principles can improve the flow of patients through the ED, resulting in greater patient satisfaction along with reduced time spent by the patient in the ED.
authors.affiliation: Emergency Department, Hôtel-Dieu Grace Hospital, Windsor, Ontario. dng@hdgh.org
authors.forename: David
authors.initials: D
authors.lastname: Ng
authors.forename: Gord
authors.initials: G
authors.lastname: Vail
authors.forename: Sophia
authors.initials: S
authors.lastname: Thomas
authors.forename: Nicki
authors.initials: N
authors.lastname: Schmidt
mesh_terms: D017598:Efficiency, Organizational / Q000592:standards*; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D009864:Ontario; D010343:Patient Admission / Q000706:statistics & numerical data; D017060:Patient Satisfaction; D017064:Process Assessment, Health Care; D012189:Retrospective Studies; D013997:Time Factors; D014218:Triage / Q000458:organization & administration*; D014850:Waiting Lists