Decreasing Oncology Patients Length of Stay In Ed Lean Study at King Hussien Cancer Center

Background: Prolonged patient stay in ER is an issue frequently raised with regards to patient safety. In addition to patient complains and dissatisfaction, it increases the risk of healthcare associated infections, increases pressure on ER staff, increases waiting time and eventually impacts bed utilization. Oncology patients frequently visits ER due to their disease nature, progression and treatment protocols (radiotherapy, chemotherapy, and hormonal therapy), in which they come in with multiple serious medical complains that need early and immediate interventions. Septic shock, neutropenic fever and electrolyte imbalance are some of these serious conditions. Aim: To decrease the length of stay of ER patients at an oncology center. Methods: Lean improvement methodology was adopted to eliminate the unnecessary waste during ER workflow. Lean improvement team was trained on lean concepts and methodology by an expert staff. ER value stream map was drawn and an initial data were collected by outside volunteers to eliminate data collection bias, then lean interactions were deployed on multidisciplinary dimensions, followed by quarterly data collection to measure the success of the interventions. It was a cycle of training, collecting data, meeting ER physicians, pharmacy, laboratory, radiology, support services, and nursing. Then implementing the proposed interventions and finally collecting data. Results: ER patients' length of stay gradually decreased by 42% from 377 minutes to 221 minutes. There were remarkable deductions in radiology procedures turn-around time by 62%, and pharmacy by 57%. Improvement in patient flow, decreasing waiting time and ultimately improved patient and family satisfaction were measured outcomes to lean project. Conclusion: Lean improvement methodology is an excellent tool to reduce the nonvalue added time and ultimately improves the patient's safety.