Utilization of Lean Principles to Improve the Discharge of Medically Ready Patients on a Pediatric Gastroenterology Service

Pediatric hospital bed availability remains a bottleneck for timely admissions from the Emergency Department (ED) or external facilities, impacting the management of acute pediatric patients. Despite the growth of bed capacity, bed constraints are on-going and characterized by patients who continue to remain inpatient despite achieving medical readiness. Patients may achieve medical readiness for safe discharge at any time during the day. However, decisions regarding a patient's readiness and disposition are often made during rounds, creating batch-and-queue lean waste and disrupting continuous flow. This study aimed to develop a proof-of-concept model to improve the flow of patient care and the discharge process within a gastroenterology (GI) service. By utilizing the A3 Lean framework and Lean Six Sigma (LSS) principles, the primary goal was to establish a continuous flow of patient care from admission through medical readiness to discharge, while eliminating delays between achieving medical readiness and issuing discharge orders.

Explain the components of the A3 Problem Solving Framework and its use toward eliminating waste in a healthcare system

Compare and contrast the use of the A3 Framework and lean principles in operational improvement to the IHI Quality Improvement PDSA and Key Driver Diagram

Understand the importance of a Current State Assessment, Gemba walk and Value Stream Mapping in an operational improvement initiative to inform the countermeasure phase of improvement

Authors

Dr. Qunibi is currently the Chief Operational Excellence Officer at Children’s Health/UTSW Medical Center, where she collaborates with medical & administrative leaders to resolve operational inefficiencies and improve patient satisfaction, decrease length of stay (with significant cost savings), and elmiate operational waste. Dr. Qunibi holds a unique background in pediatric critical care and lean operational excellence with medical education at UT Southwestern, training at Johns Hopkins Hospital, and Pediatric Critical Care Medicine Fellowship at Northwestern/Lurie Children's Hospital. She has also earned a Master of Business in Operational Excellence and Black Belt certification in Lean Six Sigma.