Abstract

Improvements in cycle time and customer satisfaction have helped Overlook Hospital Emergency Department increase in-patient volume and thus remain competitive. Median cycle time to thrombolytic treatment in early 1993 was 70 minutes, compared to the National Institutes of Health recommended maximum of 30 minutes. A process improvement team used a FADE (focus, analyze, develop, execute) approach to handle this problem. First, the team focused on the need to decrease treatment process variation and to improve interdepartmental and interdisciplinary collaboration. Second, analysis of 82 thrombolytic treatment episodes in 1993 revealed a median cycle time of 61 minutes and a standard deviation of 53 minutes. The subsequent root cause analysis linked brainstorming with rounds of multivoting. Third, the team developed assessment tools to track the impact of new work processes. Fourth, process improvement techniques were introduced; staff were trained; and the changes were executed. The result was an almost immediate decrease in cycle time to 45 minutes. By mid-1995, this had been reduced to a range of 15-26 minutes. The FADE approach has been applied to other areas, including bedside patient registration and X-ray analysis. Improvement in customer satisfaction followed review of a customer perception survey in mid-1996 that gave the department only a 77% rating. All staff on all shifts then identified 35 areas for improvement. Implementation of 85% of these ideas within 18 months led to an 86.6% rating by mid-1998.