Assembly Line Model Helps Hospital Improve ER

FierceHealthcare

December 16, 2013

An Austin, TX, hospital improved the efficiency of its emergency department (ED) by taking inspiration from an unlikely model: the assembly line.

The 241-bed Brackenridge Hospital, as a Level 1 trauma center, cannot turn any patients away from its ED, but in 2011, "[i]t wasn't sized for the number of patients coming through there," Kristie Loescher, senior lecturer at the McComb School of Business, told Know.

As a result of the limited space and high patient volume, Brackenridge's ED found itself at high risk for patient satisfaction-related penalties and readmission penalties.

Implementing suggestions from Loescher, the hospital applied critical chain theory, which promotes making assembly lines as efficient as possible by identifying the "tightest bottleneck in the chain." It then adjusted the other steps in the process accordingly, the article states.

"When you're looking at efficiency in a system, you don't care about the efficiency of each part of the system," Loescher said. "Focus on the scarce resource, and make sure that scarce resource is always working."

For Brackenridge, that resource was beds, according to the article. In response, the hospital revised procedures, reorganized rooms to make sure beds could never go empty, and implemented the Flex-Flow system, under which staff could quickly move from one role to another based on need.

Since the program's launch in January 2012, door-to-doctor time dropped to less than 30 minutes and the percentage of patients who left without getting treatment was cut in half, according to Know. Patient satisfaction scores are also on the upswing, with 48% of patients rating their service as "excellent," an increase of 15 points. In addition, Brackenridge now scores in the 50th percentile of hospitals, according to the article.

Eventually, the hospital hopes to score in the 75th percentile and have less than 1% of patients leave without treatment. "Flex-Flow cut through a lot of traditional lines and focused on what was really important," Loescher said. "It's making sure people get the care they need and focusing resources on the people who need it the most. And in the end, it's also more cost-effective."

A similar project involving a partnership between New Jersey hospitals cut wait times and stays, and is expected to reduce costs and increase revenues in New Jersey EDs, FierceHealthcare previously reported.

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