Securing the safety net : applying manufacturing systems methods towards understanding and redesigning a hospital emergency department

Abstract

Emergency Departments have been referred to as the "Safety Net" of our Healthcare system. This is because of their ability to catch all patients who would otherwise slip through the system, due to lack of funds, insurance, time, transportation and knowledge, etc. Because of this, as demand for health treatment increases, the occurrence of crowding in our nation's emergency departments is also increasing. At the same time hospitals are being expected to perform more, with lower funding. Observation of a hospital emergency department yields similarities between the emergency department and a manufacturing system. This is not completely a new concept, yet there have been barriers towards adopting manufacturing system practices into healthcare systems due to differences in culture, economics, politics, and the nature of the system itself. The focus of this thesis is to select manufacturing systems methods and apply them to an emergency department. This application is done with an understanding of the fundamental differences between the two systems. The first applied method is Axiomatic Design, a system design method that clearly maps out the functional requirements of a system to design solutions more efficiently. Upon applying Axiomatic Design to show that it can be used to discover and describe problems in an Emergency Department, the specific problem of patient flow is selected. Discrete Event Simulation is used in order to analyze patient flow in the Emergency Department. This results in actionable changes in the operations of an emergency department fast track. One significant actionable change is the creation of a new index for assigning patients a level based on their expected time in the Emergency Room to be used in conjunction with the current index which is based on acuity level. The purpose of this exercise is to show that manufacturing methods can be applied in an emergency department/healthcare system while taking the differences between the two systems into account.