title: Application of Lean principles to improve early cardiac care in the emergency department.
abstract: OBJECTIVE
  To achieve our goal of excellent emergency cardiac care, our institution embarked on a Lean process improvement initiative. We sought to examine and quantify the outcome of this project on the care of suspected acute coronary syndrome (ACS) patients in our emergency department (ED).
  
  
  METHODS
  Front-line ED staff participated in several rapid improvement events, using Lean principles and techniques such as waste elimination, supply chain streamlining, and standard work to increase the value of the early care provided to patients with suspected ACS. A chart review was also conducted. To evaluate our success, proportions of care milestones (first electrocardiogram [ECG], ECG interpretation, physician assessment, and acetylsalicylic acid [ASA] administration) meeting target times were chosen as outcome metrics in this before-and-after study.
  
  
  RESULTS
  The proportion of cases with 12-lead ECGs completed within 10 minutes of patient triage increased by 37.4% (p < 0.0001). The proportion of cases with physician assessment initiated within 60 minutes increased by 12.1% (p  =  0.0251). Times to ECG, physician assessment, and ASA administration also continued to improve significantly over time (p values < 0.0001). Post-Lean, the median time from ECG performance to physician interpretation was 3 minutes. All of these improvements were achieved using existing staff and resources.
  
  
  CONCLUSIONS
  The application of Lean principles can significantly improve attainment of early diagnostic and therapeutic milestones of emergency cardiac care in the ED.
authors.affiliation: Royal College Emergency Medicine Residency Program, University of Manitoba, Winnipeg, MB, Canada. zoepiggott@gmail.com
authors.forename: Zoë
authors.initials: Z
authors.lastname: Piggott
authors.forename: Erin
authors.initials: E
authors.lastname: Weldon
authors.forename: Trevor
authors.initials: T
authors.lastname: Strome
authors.forename: Alecs
authors.initials: A
authors.lastname: Chochinov
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000628:therapy*; D017598:Efficiency, Organizational / Q000592:standards*; D004562:Electrocardiography / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D006302:Health Services Research; D006801:Humans; D008350:Manitoba; D015279:Organizational Culture; D010043:Outcome and Process Assessment, Health Care / Q000458:organization & administration*; D058996:Quality Improvement / Q000458:organization & administration* / Q000592:standards; D014218:Triage / Q000458:organization & administration*