Redesigning an inpatient pediatric service using Lean to improve throughput efficiency.

Background: Data suggest that delays in discharges from inpatient units affect hospital throughput and contribute to emergency department crowding. Lean/Six Sigma (LSS) has been shown to improve inefficiencies in other industries. There are no published data on what impact LSS can have on advancing and sustaining earlier patient discharges.

Objective: Determine the impact LSS has on advancing times of placement of discharge order and patient discharge compared to control. Secondary outcomes were length of stay (LOS) and readmission rates.

Design: Prospective quality study with concurrent controls.

Setting: Academic medical center.

Patients: Hospitalized pediatric patients compared to remainder of the children's hospital services.

Interventions: Staff reallocation, creation of standard workflow, multidisciplinary predischarge planning, and creation of a discharge checklist.

Measurements: Median time of discharge order entry and median time of actual patient discharge, proportion of patients discharged before noon and 2 pm, and LOS and readmission rates.

Results: The median time of order entry was 10:45 compared to 14:05, and the median time of discharge was 14:15 compared to 15:48. The LOS and the readmission rates remained the same in both cohorts. The control group had faster baseline discharge order entry and patient discharge, but discharge performance did not improve, despite a significantly lower average daily census.

Conclusions: We determined that Lean approaches can have an immediate and sustained impact on advancing patient discharges, with no negative affect on LOS or readmission rates. Our intervention generated consistent results independent of personnel during the busiest months of the year at a tertiary care children's hospital.