November 27, 2017

This hospital cut its ED discharge wait time by 40% with help from a surprising source: Toyota

Daily Briefing

    Editor's note: This story was updated on Oct. 18, 2019.

    Parkland Memorial Hospital has cut its ED discharge wait time from an average of 52 minutes down to 31 minutes over the course of eight months—thanks to some help from car manufacturer Toyota, Naomi Martin writes for Dallas News.

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    Background

    According to Martin, Parkland CEO Fred Cerise earlier this year reached out to Toyota when he learned the company was opening a North American headquarters in Plano, Texas. Cerise hoped that Toyota's philanthropic arm, which provides nonprofits with no-cost consulting on how to boost efficiency, could help Parkland improve its ED—one of the busiest EDs in the country, Martin writes.

    Toyota said it would help so long as the project would not be used as part of a layoff plan. Cerise agreed, explaining, "We know we have more demand than we can meet. … So this wasn't about downsizing the operation. This was about: How can we create more capacity and get more patients through?"

    Toyota assessed Parkland's ED and decided to focus on the ED discharge wait time—defined as the amount of time, according to Martin, between when a patient is given discharge orders and when he or she leaves the hospital. As Gina Donahue, director of nursing for Parkland's emergency services, said, "Every minute a patient is in a bed and doesn't need to be there takes away from another patient [who] needs to be in a bed."

    How they did it

    To address wait times, Toyota collaborated with Parkland's front-line staff, including nurses, to assess each part of the discharge process—from paperwork to arranging social services—and brainstorm possible improvements. "It's all about empowering front-line workers," Scott Dickson, a senior manager at Toyota Production System Support Center and the head of the project, said. "It's critical that it's their idea. They're the experts."

    The team proposed, among other ideas, taking advantage of lights mounted outside the door of each patient room—which the hospital had previously declined to use because doing so involved a time-consuming code. Toyota's team worked with Parkland's IT department to configure the lights to meet the needs of the ED.

    Now, the ED team relies on a four-color light system to communciate what needs to be done in each room, with:

    • An orange light indicating that the patient is out of the room for an X-ray;
    • A green light indicating that a physician has said the patient may leave the hospital;
    • A red light indicating that the room requires a cleaning; and
    • A purple light indicating that the room is clean and ready for another patient.

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    In addition, ED staff began asking patients earlier during their stay whether they required assistance from a social worker. Toyota's team had determined that previously, discharges were frequently delayed as staff waited for a social worker to arrive—so asking earlier could cut down on delays.

    The Parkland ED also implemented a new policy requiring nurses to complete all of their discharge tasks before leaving a patient's room. Previously, nurses often would take out a patient's IVs, tell them to dress, and then leave the room to complete documentation or other tasks. After they left, nurses often found themselves distracted by other issues, such as incoming phone calls, other patients, or waiting family members—resulting in delays before final discharge.

    Positive results

    The results so far have been positive, Martin reports. Parkland has cut its ED discharge wait time from 52 minutes in February, when the program began, to 31 minutes as of September. The team is optimistic they will be able to reach their goal of reducing it even further to 15 minutes (Martin, Dallas News, 11/20).

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