The document summarizes a project to improve operations at a hospital emergency department during daily surges in patient volume. It recommends 12 best practices to reduce patient length of stay by up to an hour, lower emergency department visits by up to 20%, and save over $10 million. These recommendations were developed through literature review, lean methodology, and analyzing the hospital's processes to identify areas for increased efficiency and regulatory compliance while maintaining high quality care.

1. Project Goals/Objectives
 Management of “Daily Surge”
 Preservation of Standards of Care and Patient Dignity
 Regulatory Compliance
 Differentiation from Catastrophic Surge
 Prevention of Non-Emergent use of Disaster Protocol
Abstract
When the daily demand for emergency department services is greater than a
hospital's available capacity to respond, the hospital encounters surge. This
project focused on improving operational resiliency during non-catastrophic
daily surge at UMass Memorial Medical Center's (UMMC) emergency department.
Utilizing literature review, lean methodology, and MBA coursework, this project
recommends 12 best practices to improve emergency department operations at
UMMC. Implementation has the potential to reduce patient length of stay up to an
hour per patient, reduce the quantity of emergency department visits by up to
20%, and provide system-wide savings of over $10 million.
Conclusions
Acknowledgments
Prof. Mustapha Fofana, WPI, MIRAD Labs
Dr. Marc Gautreau, MD, UMMC
Dr. Martin Reznek, MD, UMMC
Ms. Gina Smith, RN, UMMC
Surge Protection:
Improving Operational Resiliency of Hospital Emergency Departments
David Coughlin, Jesse Demers, Brian Feldman,
Keith Ferry, Elizabeth Mitchell, Breanna Rinaldo
Advisor: Professor Sharon Wulf, WPI Foisie School of Business
Sponsor: Professor Mustapha Fofana, WPI, MIRAD Laboratories
Emergency Department Process Flow
Final Recommendations for UMMC:
Spheres of Influence
The above visual aid illustrates how our team’s recommendations align with UMMC’s
emergency department’s spheres of influence. The visual starts at the core, with the
emergency department itself, before expanding outwards to the entire hospital and
eventually external partners and stakeholders.
Recommendations with an * are considered bold or potentially high-risk, high-
reward and could be considered “stretch” goals.
The student team worked closely with UMMC to combine lean methodology, empirical validation, and advanced
MBA coursework into an assessment of 17 different potential actions culled from an extensive literature review. The
above is an aggregation of the results of the work done by the student team in collaboration with UMMC.
Bars shown in color were added to the final list of recommendations for UMMC. Bars shown in gray scale were
excluded for reasons such as underwhelming return on investment or having already been implemented at UMMC.
To learn about how the recommended actions align with UMMC’s current environment, please refer to the exhibit
“Recommendations for UMass Memorial: Spheres of Influence”.
UMMC’s Assessment of Initial Recommendations
Operational
Regulatory
Financial
Business
Acumen9.8 9.6
19.9 18.9
66.0
58.8
6.6 6.7
2009 2014 2009 2014 2009 2014 2009 2014
Massachusetts National Avg Best State Worst State
Emergency Departments per 1M Residents
Andon
Japanese for “Paper Lantern” – a visual/auditory
signal or alert identifying an issue
EDIE
Emergency Department
Information Exchange
Kaizen Bursts
Opportunities to eliminate waste
within a given system
NEDOCS
National Emergency Department
Overcrowding Scale
PCP
Primary Care Physician
Application of Lean Methodologies
Using this process flow map, the team identified 6 Kaizen
Bursts and 17 recommendations for improvement that are
applicable to the process. Initiatives that are applicable across
multiple areas of the “Throughput” section were determined to
have system-level applicability, and are shown as such.
311
272
176
452
Mass National Avg Best State Worst State
Median ED Arrival to Departure Time – 2014
(Minutes)
306 249
674
934
1762
0 177
2009 2014 2009 2014 2009 2014 2009 2014
Massachusetts National Avg Best State Worst State
Bed Surge Capacity per 1M Residents
2000+
Massachusetts Avg. ED Facts
1. Double the ED process time compared
to the best state (South Dakota)
2. Half the number of EDs per resident
compared to the national average
3. One quarter the hospital bed surge
capacity compared to the national
average
1.
2. 3.
Impact Potential for UMMC
1. Patient length of stay reduction of 40 – 60 minutes (approximately 15%)
2. Emergency Department visits reduced by 8 – 20%
3. Long-term financial savings of $10 – 27 million
Selection Filters