![Page 1: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/1.jpg)
DepartmentofEmergencyMedicine
EmergencyCriticalCareCenter:
ALeanJourney
BenBassin,MD,FACEP,EDAC
CemalSozener,MD,M.Eng,FACEP,EDAC
![Page 2: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/2.jpg)
DepartmentofEmergencyMedicine
• Customer1st
• Peoplearethemostimportant
resource
• Shopfloorfocus(GoandSee)• Kaizenisawayoflife
LeanThinking- ThingsthatMatter
![Page 3: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/3.jpg)
DepartmentofEmergencyMedicine
• A3Thinking
• GoandSee
• RapidImprovementEvents(Kaizen)
KeyLEANTools
![Page 4: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/4.jpg)
DepartmentofEmergencyMedicine
• A3Thinking
• GoandSee
• RapidImprovementEvents(Kaizen)
KeyLEANTools
![Page 5: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/5.jpg)
DepartmentofEmergencyMedicine
A3
![Page 6: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/6.jpg)
DepartmentofEmergencyMedicine
BACKGROUND/PROBLEM
![Page 7: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/7.jpg)
DepartmentofEmergencyMedicine
• Whyisthisimportant?
• Whynow?
DefiningtheproblemisCRITICAL
![Page 8: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/8.jpg)
DepartmentofEmergencyMedicine
CreateaClear,ConciseProblemStatement
“Improveaccesstotimelycriticalcareby
enhancingthecapacityandcapabilitytodeliver
highqualitycriticalcareintheAdultEmergency
DepartmentattheUniversityofMichigan.”
![Page 9: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/9.jpg)
DepartmentofEmergencyMedicine
![Page 10: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/10.jpg)
DepartmentofEmergencyMedicine
Background
![Page 11: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/11.jpg)
DepartmentofEmergencyMedicine
MichiganMedicine
![Page 12: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/12.jpg)
DepartmentofEmergencyMedicine
UMHSAdmissionStreams:ED=FrontDoor
16% 30%
54%
FY16UMHSinpt/obs admissions=66,620
![Page 13: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/13.jpg)
DepartmentofEmergencyMedicine
AnAlarmingNationalTrend
ICUadmissionsfromtheEDhaveDOUBLEDoverthelastdecade- AdmissionsfromtheED:1.2à 2.2millionfrom2001-2009
- AdmissionratefromtheED:0.9%à 1.6%
- 1/3ofallICUadmissionsspend>6hrsintheED
0
2,000,000
4,000,000
6,000,000
8,000,000
10,000,000
12,000,000
2001 2009
EDCriticalCareVisits
EDCriticalCareHours
Herringetal.Crit CareMed2013
Peryear
10%/yr
24%/yr
Growth
![Page 14: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/14.jpg)
DepartmentofEmergencyMedicine
Theeffectivenessofcriticalcare
foracuteillnessandinjuryis
time-sensitivewiththerapeutic
windowsrangingfromminutes
tohours.
AcuteCriticalCareistime-sensitive
1358 CRITICAL CARE Nguyen et al. • CRITICAL CARE IN ED
Figure 2. Predicted mortality presented as mean (%) !standard deviation computed from APACHE II andSAPS II scores in the emergency department (ED) andat intervals in the intensive care unit (ICU). Asterisk (*)indicates significant difference (p " 0.02) in predictedmortality between the corresponding time points.
TABLE 5. Predicted Mortality and Changes in Predicted Mortality (! Pred Mort) of All Patients*
APACHE II
PredictedMortality (%)
! Pred Mort (%),p-value†
SAPS II
PredictedMortality (%)
! Pred Mort (%),p-value†
0 (ED admission) 42.0 ! 20.0 — 44.0 ! 22.0 —6 (ED discharge) 34.0 ! 18.0 #8.0 ! 14.0, <0.001 38.0 ! 23.0 #6.0 ! 14.0, <0.00124 (ICU) 26.0 ! 18.0 #7.0 ! 13.0, <0.001 33.0 ! 24.0 #4.0 ! 16.0, 0.0248 21.0 ! 14.0 #1.0 ! 9.0, 0.47 27.0 ! 19.0 #2.0 ! 11.0, 0.2472 20.0 ! 12.0 #1.0 ! 6.0, 0.18 26.0 ! 18.0 #1.0 ! 8.0, 0.22
*Data are presented as mean (%) ! standard deviation computed from APACHE II and SAPS II scores in the emergencydepartment (ED) and at intervals in the intensive care unit (ICU).†P-value reflects comparison of predicted mortalities using Student’s t-test between the successive time points.
ward were excluded; therefore, all patient datawere analyzed. At ED admission, there was ahigher APACHE II score in nonsurvivors vs sur-vivors (p = 0.04), while there was no significantdifference in SAPS II or MODS scores. TheAPACHE II, SAPS II, and MODS scores were sig-nificantly lower in survivors than nonsurvivors atED discharge and throughout the study period (p" 0.001) (Table 4). General linear mixed modelingwas used to examine hourly rate of change in phys-iologic scores (Fig. 1). The hourly rates of change(decreases) in APACHE II, SAPS II, and MODSscores (#0.55 ! 0.64, #1.02 ! 1.10, and #0.16 !0.43, respectively) were significantly greater dur-ing the ED stay than subsequent periods of hos-pitalization in the survivors (p < 0.05). In the non-survivors, there was a significantly greater hourlyrate of change (decrease) in APACHE II score(#0.29 ! 1.05) compared with subsequent inter-vals during hospitalization (p = 0.02). However,there was no significant difference in the hourlyrate of change (actual increase) in SAPS II and
MODS scores between ED therapy and ICU carein the nonsurvivors. The hourly rate of change (ordecrease) in APACHE II, SAPS II, and MODSscores was uniformly greater at each time intervalin survivors compared with nonsurvivors.
There was a significant decrease in APACHE IIand SAPS II predicted mortality during the EDstay and at 24 hours in the ICU (p " 0.02) (Table5). After 24 hours there was no significant changein predicted mortality with both scoring systems.The APACHE II and SAPS II predicted mortalityapproaches actual in-hospital mortality at approx-imately 12 hours and 36 hours after ED admission(in the ICU), respectively (Fig. 2).
Mortality predictions at each time point werecompared using ROC curve analysis (Fig. 3). Therewas a stepwise increase in mortality prediction(sensitivity and specificity) as represented by theAUC from ED admission to ED discharge, and at48, 72, and 24 hours in the ICU using APACHE II.The AUC for mortality prediction using SAPS IIwas progressively increased from ED admission toED discharge, and at 24, 48, and 72 hours.
DISCUSSION
The increased provision of critical care in theED1–4 is a result of increasing patient volumes,limited ICU bed availability, increasing levels ofpatient acuity, and the use of the ED as the firstcontact for primary care. In addition, the applica-tion of therapeutic1 and monitoring23,24 technolo-gies once considered under the domain of the ICUhas made the delivery of critical care more prac-tical in the ED. Studies have quantitated that from1541 to 1864 critical-patient-days per year are pro-vided in the urban ED setting. Our data indicated464.4 critical-patient-days per year (38.7 critical-patient-days per month or 30.5 critical-patient-hours per day) were delivered at this institution.
If the findings of this study are seen in similarEDs and generalized nationally, a substantialamount of critical care is delivered in this setting.Professional organizations have recognized andare currently addressing these issues.25 The Soci-ety of Critical Care Medicine currently provides a
TheFIRST6HOURS
Mostrapidchangeinphysiology
Nguyen2000
![Page 15: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/15.jpg)
DepartmentofEmergencyMedicine
ED-ICUInterface
EDLocation ICULocation
Time0to24hr
CriticalCareNeedsBeingAddressed?
EDTeam ICUTeamNoMan’s
Land?
![Page 16: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/16.jpg)
DepartmentofEmergencyMedicine
CurrentState/Analysis
![Page 17: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/17.jpg)
DepartmentofEmergencyMedicine
![Page 18: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/18.jpg)
DepartmentofEmergencyMedicine
CurrentSituation– Wherearewenow?
![Page 19: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/19.jpg)
DepartmentofEmergencyMedicine
Currentstate2012– ICUAdmissions
• FY12 – 1,886 ICU Admits
• 5.2 per day
• ED LOS 6 hr
• Projected 10% growth
![Page 20: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/20.jpg)
DepartmentofEmergencyMedicine
Patient(Home/EMS/OSH)
ED
Admission
ICU
Floor
Discharge
DeclinedED-EDTransferRequests(750/yr)– 25%ICU
ShuntingofResourcesfrom
Non-CriticalPatients
Short-StayICUAdmissions<24hr
(440/yr)
EmergentTransfertoICUin<24hrs
(200/yr)
EC3CC
Boarding(6hrs)
CCD/CfromED?
CCinnon-CCarea
(450/1286ICUadmits–
35%)
![Page 21: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/21.jpg)
DepartmentofEmergencyMedicine
• IncreasingEDvisits
• IncreasingICUdemand(EDandtransfers)
• IncreasingEDLOSforourICUpatients
• Outcomes?
Summarytodate
(wherewewerein2012)
![Page 22: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/22.jpg)
DepartmentofEmergencyMedicine
FutureState/Goals
![Page 23: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/23.jpg)
DepartmentofEmergencyMedicine
A3
![Page 24: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/24.jpg)
DepartmentofEmergencyMedicine
FutureState
![Page 25: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/25.jpg)
DepartmentofEmergencyMedicine
ParadigmShift
![Page 26: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/26.jpg)
DepartmentofEmergencyMedicine
ApplyLEANprinciplestoproblem
identificationandsolution
![Page 27: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/27.jpg)
DepartmentofEmergencyMedicine
• Engagefrontlineworkerstocreateoptimal
workflowsandeliminatewaste
• Architectsanddesignerstransformprocess
mapsintoadesign
• Focusonremovingphysicalbarriersfrom
theworkflows
• Paradigmshiftofarchitectsfromproject
leadstoteammemberandfacilitators
LeanFacilityDesign
![Page 28: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/28.jpg)
DepartmentofEmergencyMedicine
• Purpose– fixpatients’problemsdefinitively
• Process– fundamentallyredesignthe
processes(notjusttighteninguptheold
way)
• People– atruemultidisciplinaryteam
LeanPatientFlowTransformation
![Page 29: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/29.jpg)
DepartmentofEmergencyMedicine
• Assumptions:
– Currentvolume
– EC3LOS– 12hrs
– 50%ofpatientstreatedinresuscitationbayswouldpassthroughEC3
– 10-20%ofpatientswouldnolongerneedICU
• ModelOutput:– Require5resuscitationbaysand7EC3rooms
QueueingModel
![Page 30: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/30.jpg)
DepartmentofEmergencyMedicine
GrowthProjection
![Page 31: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/31.jpg)
DepartmentofEmergencyMedicine
ProposedFutureState
5
![Page 32: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/32.jpg)
DepartmentofEmergencyMedicine
CreatingaMultidisciplinaryTeam
![Page 33: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/33.jpg)
DepartmentofEmergencyMedicine
Manyteammeetings2yearsprior
![Page 34: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/34.jpg)
DepartmentofEmergencyMedicine
• A3Thinking
• GoandSee
• RapidImprovementEvents(Kaizen)
KeyLEANTools
![Page 35: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/35.jpg)
DepartmentofEmergencyMedicine
Roadtrips
![Page 36: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/36.jpg)
DepartmentofEmergencyMedicine
SCHEMATICDESIGN
![Page 37: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/37.jpg)
DepartmentofEmergencyMedicine
![Page 38: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/38.jpg)
DepartmentofEmergencyMedicine
![Page 39: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/39.jpg)
DepartmentofEmergencyMedicine
EC3v1.0
![Page 40: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/40.jpg)
DepartmentofEmergencyMedicine
FullScaleMock-up
![Page 41: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/41.jpg)
DepartmentofEmergencyMedicine
UtilizeActualEquipment
![Page 42: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/42.jpg)
DepartmentofEmergencyMedicine
MultidisciplinaryTeams
![Page 43: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/43.jpg)
DepartmentofEmergencyMedicine
MultidisciplinaryTeams
![Page 44: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/44.jpg)
DepartmentofEmergencyMedicine
Egress
![Page 45: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/45.jpg)
DepartmentofEmergencyMedicine
ImmovableBarriers
![Page 46: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/46.jpg)
DepartmentofEmergencyMedicine
IdeaBoards
![Page 47: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/47.jpg)
DepartmentofEmergencyMedicine
IdeaBoards
![Page 48: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/48.jpg)
DepartmentofEmergencyMedicine
• Thisisareallygoodidea
• NoprecedentatMM
• Empowering/Inclusive/Unifying
• SignificantdesignchangesBEFORE
construction• Nosignificantchangeorders
• Underbudget
• Aheadofschedule
MockupLessonsLearned
![Page 49: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/49.jpg)
DepartmentofEmergencyMedicine
![Page 50: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/50.jpg)
DepartmentofEmergencyMedicine
EmergencyCriticalCareCenter
99
98 97 96 95
92
9394
EDCBA
91
EmergencyCriticalCareCenter(EC3)(91-99)
EDResuscitationBays(A-E) AmbulanceEntrance
![Page 51: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/51.jpg)
DepartmentofEmergencyMedicine
BringintheMuscle…
September2014
![Page 52: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/52.jpg)
DepartmentofEmergencyMedicine
![Page 53: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/53.jpg)
DepartmentofEmergencyMedicine
![Page 54: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/54.jpg)
DepartmentofEmergencyMedicine
ImplementationPlan
![Page 55: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/55.jpg)
DepartmentofEmergencyMedicine
![Page 56: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/56.jpg)
DepartmentofEmergencyMedicine
JoyceandDonMasseyFamilyFoundation
EmergencyCriticalCareCenter(EC3)
GrandopeningFebruary16,2015
![Page 57: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/57.jpg)
DepartmentofEmergencyMedicine
LEANDESIGNFEATURES
![Page 58: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/58.jpg)
DepartmentofEmergencyMedicine
• Cold,CATscanin
zone
• Nocrowdcontrol
• Patientsand
familiesnotin
ideal
environmentat
theirgreatest
timeofneed.
Before– 3bedResuscitationBay
![Page 59: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/59.jpg)
DepartmentofEmergencyMedicine
OldResus Bay
Cluttered,old,
poorlydesigned
boomsystems.
ERfleamarketwith
tonsofequipment
pushedtotheback.
Can’tfindanything
quickly
![Page 60: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/60.jpg)
DepartmentofEmergencyMedicine
![Page 61: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/61.jpg)
DepartmentofEmergencyMedicine
DirectAccess
toEC3
Multiple
Video
Displays
Camerasfor
QAand
Teaching
![Page 62: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/62.jpg)
DepartmentofEmergencyMedicine
Dedicated
Nurse
Charting
Station
Dedicated
Physician
OrderEntry
![Page 63: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/63.jpg)
DepartmentofEmergencyMedicine
Abilitytocarefor
multiplepatients
Power,Data
andGas-
360˚
![Page 64: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/64.jpg)
DepartmentofEmergencyMedicine
In-situ
teaching
technology
![Page 65: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/65.jpg)
DepartmentofEmergencyMedicine
CustomCarts
toMaximize
Spaceand
Efficiency
![Page 66: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/66.jpg)
DepartmentofEmergencyMedicine
Transaction
Height
Counters
KeepCarts
outof
Corridor
![Page 67: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/67.jpg)
DepartmentofEmergencyMedicine
LineofSight
toResus Bays
![Page 68: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/68.jpg)
DepartmentofEmergencyMedicine
OpenLineof
SightAcross
Unit
![Page 69: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/69.jpg)
DepartmentofEmergencyMedicine
![Page 70: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/70.jpg)
DepartmentofEmergencyMedicine
Ambient
LightHOB
ClearBariatric
Lifts
Dialysis
Boxes
Negative
Pressure
![Page 71: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/71.jpg)
DepartmentofEmergencyMedicine
PatientCareSpaces
FamilyZone PatientZone CaregiverZone
![Page 72: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/72.jpg)
DepartmentofEmergencyMedicine
EARLYRESULTSANDTARGETMETRICS
![Page 73: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/73.jpg)
DepartmentofEmergencyMedicine
Patient(Home/EMS/OSH)
ED
Admission
ICU
Floor
Discharge
DeclinedED-EDTransferRequests(750/yr – 25%ICU)
ShuntingofResourcesfrom
Non-CriticalPatients
Short-StayICUAdmissions<24hr
(440/yr)
EmergentTransfertoICUin<24hrs
(200/yr)
EC3CCinnon-CC
area(450/1886ICUadmits–
24%)
CCBoarding(6hrs)
CCD/CfromED?
DeclinedED-EDTransferRequests(597/yr – 9%ICU)
14dedicatedbedsforCC
EC3– 0hrsIfnoEC3–2.5hrs
Decreased43%
IncreasedICU-ICUAcceptedTransfer32%incr FY16
0%change=safestrategy
9%(460pts)
CCinnon-CCarea
(229/1816ICUadmits–
12%)
![Page 74: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/74.jpg)
DepartmentofEmergencyMedicine
• Improveaccesstotimelycriticalcareby
enhancingthecapacityandcapabilityto
deliverhighqualitycriticalcareintheAdult
EmergencyDepartmentattheUniversityof
Michigan.
• Inreality,themodelhascompletely
changedtheED&ICUhealthcaredelivery
paradigm
Summary/Conclusion
![Page 75: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/75.jpg)
DepartmentofEmergencyMedicine
Thankyou
![Page 76: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/76.jpg)
DepartmentofEmergencyMedicine
Questions?
![Page 77: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/77.jpg)
DepartmentofEmergencyMedicine
![Page 78: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/78.jpg)
DepartmentofEmergencyMedicine
RAPIDIMPROVEMENTEVENTS(KAIZEN)
![Page 79: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/79.jpg)
DepartmentofEmergencyMedicine
ExcessEquipment
![Page 80: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/80.jpg)
DepartmentofEmergencyMedicine
ProceduralLineCarts
![Page 81: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/81.jpg)
DepartmentofEmergencyMedicine
NewLineCart
![Page 82: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/82.jpg)
DepartmentofEmergencyMedicine
Airwaycartredesign
17 1
![Page 83: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/83.jpg)
DepartmentofEmergencyMedicine
Airwaycartredesign
![Page 84: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/84.jpg)
DepartmentofEmergencyMedicine
AppliedPrinciples
![Page 85: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/85.jpg)
DepartmentofEmergencyMedicine
Content Title
• Add content here• Add content here• Add content here
DepartmentofEmergencyMedicine
![Page 86: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/86.jpg)
DepartmentofEmergencyMedicine
EmergencyCriticalCareCenter
99
98 97 96 95
92
9394
EDCBA
91
EmergencyCriticalCareCenter
![Page 87: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/87.jpg)
DepartmentofEmergencyMedicine
ED:EC3:Floorv.Pre-EC3Baseline
1 2 3 4 5 6 7 8-14 15+ ED:EC3:Floorv.Pre-EC3Baseline -350.42 -2,276.61 -2,498.15 -2,695.02 -2,882.40 -2,697.81 -2,886.92 -2,736.51 -2,230.10
-3,500.00
-3,000.00
-2,500.00
-2,000.00
-1,500.00
-1,000.00
-500.00
0.00
Cost
LOS(days)
![Page 88: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/88.jpg)
DepartmentofEmergencyMedicine
• Patientmix Tertiary/quaternarycare
• Currentvolume 67,014/year
• Admitrate 35.4%
• ICUadmitrate 10%ofadmissions
• TransfersfromoutsideED 3440/year~300/month
• Transfersdeclined 750/year(25%ICUlevel)
• LWBSRate 3%
• Volumeprojections 3-4%overall,10%criticalcare
• ICUadmitsw/LOS< 24hrs ~440/yr
• FloortoICUTxfr < 24hrs ~200/yr
CurrentState- AdultEmergencyServicesFY12
![Page 89: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/89.jpg)
DepartmentofEmergencyMedicine
TimeinEDwaitingforICUbed…
0
1
2
3
4
5
Reference Chalfin2007 Rincon2010 Singer2011 Hung2014 Cha2015
OddsRatiofordeath
>6hr
>5hr
>12hr
>4hr >6hr
![Page 90: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/90.jpg)
DepartmentofEmergencyMedicine
• Average7patientsperday• MedianEC3LOSICUadmit=7.2hr• MedianEC3LOSNon-ICUadmit=12hr
Results:EC3OperationalCharacteristics
BiPap/Intubation/Vent 595 11.5%DKA 276 5.3%EndofLife 61 1.2%GIBleed 421 8.1%PostCardiacArrest 84 1.6%Sepsis 794 15.4%ShortnessofBreath 514 9.9%StatusEpilepticus 57 1.1%SubarachnoidHemorrhage 133 2.6%Undifferentiated 2,546 49.2%Unknown 391 7.6%
EC3PathwayMultipleperpatientpossible Count %
![Page 91: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/91.jpg)
DepartmentofEmergencyMedicine
Pre-EC3(744d)
Post-EC3(744d)
RelativeChange
OverallED Visits 147,030 157,190 6.9%
HospitalAdmissions 51,451 55,912 8.7%
ICUAdmissions 3,742 3,279 -12.4%
Results:EDVisitsandAdmissions
![Page 92: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/92.jpg)
DepartmentofEmergencyMedicine
Total EDVisits
ICUAdmission
ICUAdmission
Rate
95%CI
Pre-EC3 147,030 3,742 2.54% 2.4-2.6%
Post-EC3 157,190 3,279 2.08% 2.0-2.2%
EC3AssociatedwithDecreased
ICUAdmissionRatefromED
Relative Risk Reduction = 18% [95%CI:11-23%]Number Needed To Treat = 218 [95%CI:174-361]
![Page 93: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/93.jpg)
DepartmentofEmergencyMedicine
TotalAdmissions
TransfertoICU
≤24hrsafteradmittoward
Rate
Pre-EC3 51,451 377 0.8%
Post-EC3 55,912 400 0.8%
EC3NotAssociatedwithIncreased
TransferstoICUwithin24hoursof
GeneralWardAdmission
![Page 94: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/94.jpg)
DepartmentofEmergencyMedicine
TotalEDAdmissions
Death≤48hrsafter
admission
MortalityRate
Pre-EC3 51,451 280 0.54%
Post-EC3 55,912 281 0.50%
EC3NotAssociatedwithIncreased
ShortTerm(≤48hrs)Mortality
![Page 95: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/95.jpg)
DepartmentofEmergencyMedicine
ICUBedDaysSaved
MinimumICUBedDaysSaved1 1,188AverageperMonth2 51.4AverageperDay2 1.7MedianICUBedDaysSaved 3,326AverageperMonth2 143.3AverageperDay2 4.7
![Page 96: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/96.jpg)
DepartmentofEmergencyMedicine
Reductionin“ShortStay”ICU
Admissions
![Page 97: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/97.jpg)
DepartmentofEmergencyMedicine
ReducingMedicalICUAdmissions
![Page 98: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/98.jpg)
DepartmentofEmergencyMedicine
DiseaseSpecificOrderSets
Undifferen
tiatedSepsis
BiPap/Intu
bation/
Vent
Shortness
ofBreath
Feb-16*
GIBleed UnknownDKAAug-
15*
Subarachn
oid
Hemorrha
ge
Post
Cardiac
Arrest
EndofLife
Dec-15*
Status
Epilepticus
EC3Pathway 49.2% 15.4% 11.5% 9.9% 8.1% 7.6% 5.3% 2.6% 1.6% 1.2% 1.1%
2,546
794
595514
421 391276
133 84 61 57
-5.0%
5.0%
15.0%
25.0%
35.0%
45.0%
55.0% EC3PathwaysUtilized
Multipleperpatientpossible2/16/2015- 2/28/2017
n=5,872
%ofT
otalEC3
StatusP
atients
*Dateorderset started
![Page 99: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/99.jpg)
DepartmentofEmergencyMedicine
DiseaseSpecificOrderSets
![Page 100: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/100.jpg)
DepartmentofEmergencyMedicine
LengthofStay&CostAnalysis
![Page 101: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/101.jpg)
DepartmentofEmergencyMedicine
LengthofStay
MedianHospitalLOS MedianICULOSPreEC3 PostEC3
EDtoMICU 6.00
ED toEC3 toMICU 7.00
ED toEC3 toFloor 4.00
PreEC3 PostEC3
ED toMICU 2.00
ED toEC3 toMICU 3.00
0.00
0.50
1.00
1.50
2.00
2.50
3.00
3.50
ED:MICU ED:EC3:MICU
Med
ianICULO
S
PatientPathway
PreEC3
PostEC3
0.00
1.00
2.00
3.00
4.00
5.00
6.00
7.00
8.00
ED:MICU ED:EC3:MICU ED:EC3:Floor
Med
ianHo
spita
lLOS
PatientPathway
PreEC3
PostEC3
![Page 102: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/102.jpg)
DepartmentofEmergencyMedicine
CostComponents
Cost
Radiology
X-ray
CT
MRI
Ultrasound
Pharmacy Nursing LabTestsAncillarySupport
RT
PT
OT
SpeechLanguagePathology
OtherTests
EKG
EEG
Echo
![Page 103: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/103.jpg)
DepartmentofEmergencyMedicine
EC3CostComparison
$0.00
$1,000.00
$2,000.00
$3,000.00
$4,000.00
$5,000.00
$6,000.00
$7,000.00
$8,000.00
1 2 3 4 5 6 7 8 9
Cost
LOS(days)
EC3CostComparison
ED:EC3:MICU
ED:EC3:Floor
Pre-EC3:Baseline
![Page 104: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/104.jpg)
DepartmentofEmergencyMedicine
ED
ICU WARDWithin24hours
- 4xlongertogettoICU
- O.R.Death3.07
Molina2014
WARDàICUtransferisalsoassociatedwithincreasedmortality
AnOpportunity
![Page 105: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/105.jpg)
DepartmentofEmergencyMedicine
• 7.5AttendingFTEs
• 7PAFTEs
• 40NursingFTEs
• DedicatedRT
IncrementalFTEs
![Page 106: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/106.jpg)
DepartmentofEmergencyMedicine
• Transitionzonebetweenacuteresuscitation
andongoingcriticalcaredelivery
• Needs-basedtreatmentvsgeography
–RightCareRightNow
• Timesensitive,nottimelimited
ED-ICUinterface
![Page 107: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/107.jpg)
DepartmentofEmergencyMedicine
Scope
![Page 108: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/108.jpg)
DepartmentofEmergencyMedicine
• Internalaudit– Needsbasedassessmentofcurrentstate
• CriticalCareAssessment
– Siloed
– Specificspaceforspecializedcare
• EmergencyMedicineAssessment
– EmergencyCriticalCareemergingspecialty(care/education/research)
– Currentstaffingmodel
– Currentphysicalplant
Roadmap
![Page 109: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/109.jpg)
DepartmentofEmergencyMedicine
StaffingModel
Attending1 Attending2
PA/Fellow/ResidentA PA/Fellow/ResidentB
PA/Fellow/ResidentC PA/Fellow/ResidentD
EC3BedsideRNx4(2:1)
EC3TeamLeadRNx1(1:1)
RespiratoryTherapy
Pharmacy
MedicalProvider
Nursing
Ancillary
24Hours
Laboratory
![Page 110: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/110.jpg)
DepartmentofEmergencyMedicine
ImplementationPlan
![Page 111: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/111.jpg)
DepartmentofEmergencyMedicine
EC3:LogisticsandPatientFlow
EMS/Triage
ResusBay
EC3
DefinitiveCare ICU Ward Discharge
PalliativeCare
MainEDPatientSelection
Pushvs.Pull
90-120min
LOS11hrs (2-50hrs)
CollaborativeDisposition
![Page 112: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/112.jpg)
DepartmentofEmergencyMedicine
RibbonCutting– Feb2015
![Page 113: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/113.jpg)
DepartmentofEmergencyMedicine
• Defects
• Overproduction
• Waiting
• ExcessProcessing
• Transporting
• Inventory
• Motion
• NotUsingTalent
EightWastesofHealthcare
Grunden andHagood.Lean-LedHospitalDesign.CRCPress;2012:13-14
![Page 114: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/114.jpg)
DepartmentofEmergencyMedicine
CostImpactofLEAN
SavingsOverTime
HigherUpFront
Investin
Personnel/LEAN
Leadership
Process
Improvement
Reduces
Cost/Increases
ValueOver
Time
Returns
![Page 115: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/115.jpg)
DepartmentofEmergencyMedicine
IntensityofEDServicesIncreasing
![Page 116: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/116.jpg)
DepartmentofEmergencyMedicine
• CCadvisorygroupformedin2012–– MedicaldirectorsandunitrepresentativesfromallinpatientadultICUs
• Agreeduponbasictreatmentprotocol/strategyformostcommonadmissions– Sepsis
– Cardiacarrest
– RespiratoryFailure
– GIBleed
– Anticoagulationreversal
– SAH
CollaborativeModel
![Page 117: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/117.jpg)
DepartmentofEmergencyMedicine
• IntroductiontoMichiganMedicine
• DefineLEAN
• LEANTools
• PressuresAffectingEmergencyCare
• DemonstrativeCasePresentation
• Summary/Wrap-Up
Outline
![Page 118: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/118.jpg)
DepartmentofEmergencyMedicine
• Engageallworkers
– Frontline,MiddleManagement,AdminLeadership
– AllJobFamiliesAffectingPatientExperience
• Empowers
• FostersTeamworkAcrossJobFamilies
• FrequentlyUncoverLargerSystemsIssues
• Leaders’primaryjobistogrowmoreleaders
People
![Page 119: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/119.jpg)
DepartmentofEmergencyMedicine
Quality• ValuenotVolume
• HospitalAcquiredInfections
• MedicalErrors
Flow• IncreasingVolumes
• SickerPatients
• LackofPCPAccess
Financial• RisingCosts
• DecreasingReimbursement
• CapitatedPayments
• AccountableCare
• RepurposingExistingSpace
EmergencyCareSystemStressors
![Page 120: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/120.jpg)
DepartmentofEmergencyMedicine
PhysicalSpaceInsufficienttoMeetCurrent&
ForecastedDemand
![Page 121: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/121.jpg)
DepartmentofEmergencyMedicine
FullScaleMock-up
![Page 122: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/122.jpg)
DepartmentofEmergencyMedicine
MultidisciplinaryTeams
![Page 123: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/123.jpg)
DepartmentofEmergencyMedicine
•ExecutionoftheUMHSStrategicPlantodouble adulthighcomplexitymarketshare (from6%- to12%)willamplifythe
demandforemergencycriticalcareinoursystem
•Theemergencycaresystem,init'scurrentstructure,isnotpreparedtorespondtothesechallenges.
HealthSystemStrategicPlan
![Page 124: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/124.jpg)
DepartmentofEmergencyMedicine
Roadtrips
![Page 125: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/125.jpg)
DepartmentofEmergencyMedicine
![Page 126: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/126.jpg)
DepartmentofEmergencyMedicine
![Page 127: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/127.jpg)
DepartmentofEmergencyMedicine
Centralized,commonlyused
items
Rarelyusedbutcritical
proceduralitems
![Page 128: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/128.jpg)
DepartmentofEmergencyMedicine
MichiganMedicine- Facts&Figures
![Page 129: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/129.jpg)
DepartmentofEmergencyMedicine
![Page 130: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/130.jpg)
DepartmentofEmergencyMedicine
GoldenTickets
![Page 131: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/131.jpg)
DepartmentofEmergencyMedicine
LessonsLearned
![Page 132: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/132.jpg)
DepartmentofEmergencyMedicine
StorageSpace/Technology
![Page 133: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/133.jpg)
DepartmentofEmergencyMedicine
FullScaleMock-up
![Page 134: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/134.jpg)
DepartmentofEmergencyMedicine
ValueStreamMapping
![Page 135: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/135.jpg)
DepartmentofEmergencyMedicine
![Page 136: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/136.jpg)
DepartmentofEmergencyMedicine
• file:///.file/id=6571367.12173219
![Page 137: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/137.jpg)
DepartmentofEmergencyMedicine
Fiberoptic video
imagecanbe
displayedonmultiple
HDscreensaround
RESUSbay
![Page 138: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/138.jpg)
DepartmentofEmergencyMedicine
![Page 139: Emergency Critical Care Center: A Lean Journey - .GLOBAL · 2001 2009 ED Critical Care Visits ED Critical Care Hours Herring et al. CritCare Med 2013 r 10%/yr 24%/yr Growth Department](https://reader034.vdocuments.net/reader034/viewer/2022051607/60395fa50b0c8729ea45ca8d/html5/thumbnails/139.jpg)
DepartmentofEmergencyMedicine