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A PEM group is performing a quality improvement initiative to improve ED flow in the busy evening shift of their 12-bed PED. They implement a fast-track using three patient care rooms, one nurse, and one physician. They gather data after implementation but find that ED flow is not improved because of the loss of ¼ of their patient care rooms to the new fast track. They then adjust their initiative to using only two rooms and re-gather data.
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November 26, 2022 at 12:05 am
C) Performing a Plan-Do-Study-Act (PDSA) cycle
The group created a Plan (fast-track), implemented it (Do), studied the outcome, and then acted on the results of that study to modify the plan. Lean principles originated with Toyota production and have been adapted to improve flow in healthcare. Walking the Gemba refers to observing the actual workplace (the PED) with the actual workers (nurses and clinicians) to identify areas of improvement. Process mapping refers to mapping out step by step a process (such as the process of a patient being seen in the PED: triage, registration, waiting room, nursing evaluation, physician evaluation, testing, disposition) and any delays at each step. Another quality improvement tool is the creation of a Driver Diagram, identifying the primary “drivers” influencing a stated goal. Root cause analyses look for process or system failures contributing to an undesired outcome.