Quality in Health

By Aaron Fuhrman and Daniel Gonzalez

Wait Time for Treatment

in Hospital ED

SIGMA LEVEL

• Sigma level: min(µ-LCL,UCL-µ/(Std.Dev)

• The current sigma level for the waiting time in hospitals ED came up to

have a 3sigma (which is 66810ppm)

• The breakthrough team project manages to reduce the wait time to 30-40

minutes improving annually 50%

• 3.4=66810(1-0.5)x 5.08905x10-5=(0.5)x 14 years to reach “six

sigma”

Mean 98.72222222

Std. Deviation 16.88349695

UCL 149.3727131

LCL 48.07173138

DEFINE

• The objective of this project was to minimize the waiting time in emergency hospitals.

From 2003 to 2009 the wait time has increased 25%, from 46.5 minutes to 58.1

minutes, converting this into an important issue to be solved. After obtaining data from

2013 from 54 different hospitals we found out that the waiting time for ED has

increased, accounting for a mean of 98.72 minutes. This number is unacceptable for

the patience.

• The data from 2003 to 2009 was obtained from an organization called center of

disease and control prevention whilst the data from the different hospitals in 2013 was

obtained from “beckers hospital review”.

• Excel was used to analyze the data. Scatter plots were generated to analyze the

trends of the mean and median of the historical data.

• Minitab was used to analyze the normal distribution to confirm that it is normally

distributed in order to obtain a sigma level. We also did a histogram to create the

frequency vs minutes in the emergency department.

Business Case:

• This project supports the business

quality goals on reducing the waiting

time in ED hospitals by 500%

annually and improve customer

satisfaction by 1000%

Opportunity Statement:

• An opportunity exists to reduce the

gap between our patient expectations

(less waiting time) and hospital

performance

Goal Statement:

• Reduce the waiting time in

emergency department hospitals and

implement a 50% annual

improvement in quality level to reach

six sigma

Project Scope:

• Overall response cycle time is

measured from when the patient

arrives to the ED hospital until the

doctor sees the patient

Project Plan:

Activity Start End

Define 8/28 8/29

Measure 8/29 8/30

Analyze 9/01 9/03

Control 9/04 9/05

Team:

Daniel Gonzalez

Aaron Fuhrman

Project Charter

Measure(Historical Records)

Year Mean Median

2003 46.7 27

2004 47.5 29

2005 56.1 31

2006 55.8 31

2007 57.2 32

2008 56.7 35

2009 58.1 33

46.5 47.5

56.1 55.8 57.2 56.7 58.1

0

10

20

30

40

50

60

70

2002 2003 2004 2005 2006 2007 2008 2009 2010

Me

an

Year

Waiting time in US Hospitals on ED

Mean

2729

31 3133

3533

0

5

10

15

20

25

30

35

40

2002 2003 2004 2005 2006 2007 2008 2009 2010

Me

dia

n

Mean

Waiting time in US Hospitals on ED

Median

• The data collected on the internet

was used to create scatter charts to

better understand the information

• We can observe from this graphs

that from 2003 through 2009, the

mean waiting time increased 25%,

from 46.5 minutes to 58.1 minutes.

Present Data

13212010896847260

10

8

6

4

2

0

Mean 98.72

StDev 17.04

N 54

Minutes

Fre

qu

en

cy

Normal

Normal Distribution

12010896847260

10

8

6

4

2

0

Minutes

Fre

qu

en

cy

Mean Waiting time for Hospital

Steam Leaf

6 0 2 4 5

7 3 5 5 8

8 3 3 3 5 5 5 7

9 0 0 0 2 3 5 7 8

10 0 0 0 0 1 2 4 5 5 8 8

11

0 0 0 0 2 2 2 5 5 5 7

8 8 8 8

12 0 0 0 0 0

Analyze

0 10 20 30 40 50 60 70

Immediate (2%)

Emergent (10%)

Urgent(41%)

Semiurgent (35%)

Nonurgent(7%)

No triage (4%)

Mean emergency department wait time for treatment, by urgency of patient care.

0 10 20 30 40 50 60 70

Ambulance (33%)

No ambulance (40%)

Unknown (27%)

Mean Wait Time in Minutes

Mean wait time for hospitals

Analyze

• After 2003 the waiting time started to slowly increase in the emergency

departments in US Hospitals

• The most frequent number in the waiting time among the different hospitals in 2013

accounted for a mean wait of 120 minutes, with a frequency of 10 different hospitals

• In 2009, EDs with any ambulance diversion during the previous year were

associated with longer waiting times, compared with EDs without ambulance

diversions

• Longer waiting times were associated with EDs in urban areas (62.4 minutes),

compared with nonurban areas (40.0 minutes).

• 2% percent of ED patients were triaged as needing to be seen in less than 1 minute

(immediate); 10% were triaged as needing to be seen within 1–14 minutes

(emergent); 41% were triaged as needing to be seen within 15–60 minutes

(urgent); 35% were triaged as needing to be seen within 1–2 hours (semiurgent);

and 7% of patients were triaged as needing to be seen between 2 and 24 hours

(nonurgent). No triage system for the remaining 4% of patients.

Fish-Bone Diagram

Prioritie

sMethod

Society Environment

Commute

Accidents

population

Urban

Non-Urban

Ambulance

No diversion

Breakthrough Teams

Doctors par level

Immediate

Semi-urgent

Urgent

Emergent

Non-urgent

Waiting

Time

Mean Waiting Time of 54

Random Hospitals in EDMean 98.72222222

Std. Deviation 16.88349695

UCL 149.3727131

LCL 48.07173138

40

60

80

100

120

140

160

1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52

Min

ute

s

Hospitals

Control Chart

UCL

LCL

Values

Improve

• Change the process to the Breakthrough Team system

• This system will adopt the “Toyota Lean Manufacturing Process”

which focuses upon improving the flow of work, thereby eliminating

“un-evenness” through the system.

• With this process, staff members have been able improve how

patients were being processed in the emergency room, have

identified and removed redundant steps in the process, designed a

more patient-centered flow, and evaluated results to ensure

sustainment

• Another solution is to increment the par levels of doctors in the

hospitals. However this method is more costly than the previous

one

Control

To ensure that the new process is under control, we provided a new

system which reduces the waiting time to 30 minutes (a 50% increase)

Reference

• Hing, Esther. "Wait Time for Treatment in Hospital Emergency

Departments." Centers for Disease Control and Prevention.

Centers for Disease Control and Prevention, 28 Aug. 2012. Web.

08 Sept. 2014.

• "Reduced Wait Times, More Efficient Emergency Departments."

Reduced Wait Times, More Efficient Emergency Departments.

NYC Gov, 12 May 2013. Web. 08 Sept. 2014.

• Rizzo, Ellie. "Hospitals With the Shortest ED Wait Times." Hospitals

With the Shortest ED Wait Times. Beckers Hospital Review, 2012.

Web. 08 Sept. 2014.