The document summarizes a LEAN project at St. Vincent Williamsport Hospital to reduce the average time for emergency department patient disposition to inpatient admission. The average time was 94 minutes, exceeding the goal of 60 minutes or less. The project team defined the problem, measured the current state, analyzed causes of delays, improved handoff processes between departments, and outlined control plans to sustain changes through leadership, collaboration and data collection.

1. ED DISPOSITION TIME
at St. Vincent Williamsport Hospital
Kiera Bonebrake
Team Leader
Abby Bullerdick
User Representative
Rachel Noyes
Administrator
Sara Sims
User Representative
Leah Steele
Designer
Lindsey Waltz
Implementer

2. LEAN Project
• St. Vincent Williamsport Hospital
• Critical Access Hospital
• Problem with disposition times from Emergency
Department (ED) to In Patient unit (IP)
• Disposition time: a measurement of the time when the
physician admits the patient from the ED until the patient
is taken to IP unit
• Involves both the ED and IP, however our group’s focus
is on the ED aspect
• Main Stakeholders: Patients, Trina Marlatt (CNO),
Physicians, RNs, housekeeping, technicians, secretaries, and
all other St. Vincent Williamsport Hospital employees

4. Define
Problem statement:
• The average time at St. Vincent Williamsport Hospital for emergency department (ED) disposition to inpatient
admission is 94 minutes.
Background:
• Prolonged disposition times and ED crowding compromises care quality, increases costs, and compromises
community trust. Furthermore, ED crowding will be measured by Centers for Medicare & Medicaid Services (CMS)
under the Hospital Inpatient Quality Reporting Program initiative. By improving patient flow hospital-wide, this
problem can be improved (McHugh, Van Dyke, McClelland, & Moss, 2011).
• The desired level of performance is 60 minutes or less.
• Due to the prolonged disposition wait time, the following have occurred:
• Intergroup hostility between units has increased
• A delay in patient care has developed
• HCAHPS scores have decreased
• Current score of 54.8%
• Target score of ≥70%
• There has been a projected loss in revenue to the ED.
• According to Pines, Batt, Hilton, and Terwiesch, “A 1-hour reduction in ED boarding time
would result in $9,693 to $13,298 of additional daily revenue from capturing left without being
seen and diverted ambulance patients” (2010, p. 331).

5. Measure: Current State Map

6. Measure

7. Analyze

8. Analyze

9. Improve: Future State Map

10. Improve
Deliverables
• SAINT Handoff Reporting Tool
• Time Data Collection Tool
• Bed Placement Checklist
Recommendations
• Inpatient RN should always be the one to
transfer the patient from the ED
• Inpatient RN ensures PRN orders are obtained
from ED physician during patient handoff in
the ED
• Inpatient RN will pick up patient from ED
within 30 minutes of bed assignment
confirmation
• If inpatient RN does not get patient within 30
minutes then ED RN will transfer patient to
inpatient unit

11. Improve

12. Control

13. Control

14. Management and Leadership Principles
•Delegation
•“Defined simply as getting work done through others or as directing the performance of one
or more people to accomplish organizational goals” (Marquis and Huston, 2012).
•Collaboration
•“All parties set aside their original goals and work together to establish a supraordinate or
priority common goal” (Marquis and Huston, 2012).

15. Conclusion
• Going forward
• Data collection
• Discover more areas of waste
• Implement SAINT tool and bed placement checklist
• Continued interdisciplinary communication
• Reinforcement of the process by leadership
• Scheduling meetings at each interval of process implementation
to evaluate current state and make further improvements
• Encourage staff communication