Bethesda North Hospital


Project Title: Implementation of Lean Practices within the Emergency Department

Company Profile: Over the past 40 years Bethesda North, part of TriHealth since 1995, has grown to become one of the largest acute and tertiary care hospitals in the Cincinnati region. It offers a comprehensive range of services to residents of northeast Cincinnati and Warren, Butler and Clermont counties.

Situation and Project: The Bethesda North ED is a high volume, high acuity department that admits over 14,000 patients per year to the hospital. Although ED visits had remained relatively flat from 2004-2009, the length of stay (LOS) increased an average of 6.9 hours impacting patient satisfactions cores. Additionally, patients arriving at the Emergency Department were waiting an average of 58 minutes before seeing a physician. As a result, the long waits were negatively affecting Bethesda North’s patient satisfaction--the hospital ranked in the 55th percentile compared to other Emergency Departments across the nation. Around the same time frame, the increased competition from over 14 facilities offering urgent care, clinics, etc. impacted their revenue growth.

A multi-disciplinary team from Bethesda North worked with TechSolve for six months. The team reviewed existing practices at every stage of a patient emergency room visit and looked for opportunities to apply Lean techniques and improve ED throughput by making improvements related to staffing and standardized work processes, including the following:
  • Determined top 5 focus areas utilizing a combination of both LEAN methodology and data collection
  • Conducted rapid improvement events (RIEs) in the top five key focus areas
  • Created a database for metrics reporting

Results: Process improvements were implemented to expedite test orders and enhance staff communication. A triage nurse was added to greet patients as soon as they arrived to quickly assess the level of care needed. Supplies were also organized and standardized to reduce the time staff spent looking for items. Other results included:
  • Reduced average Door to Doc time from 58 minutes to 31 minutes--an improvement of nearly 54%.
  • Increased patient satisfaction to the 95th percentile, far exceeding the target goal of the 75th percentile.
  • Potential revenue generation of $2.3M due to the increased capacity of the ED without increasing beds or staff
  • Created dashboard to allow for real-time results reporting

Case Study PDF