Rapid assessment and disposition: applying LEAN in the emergency department.

The nation's emergency rooms are overflowing with patients who endure increasingly long waits to be examined and treated. When our large metropolitan adult acute care hospital adopted LEAN as its standard operating procedure, we began to examine our processes from the customers' perspective and identified a significant opportunity to reduce the emergency department length of stay. Using LEAN tools we designed and implemented a Rapid Assessment and Disposition process to decrease the amount of time patients waited in the emergency department, reduce diversion time, and reduce the number of patients who left without being seen. We have succeeded in reducing the average length of stay for all emergency department patients by 45 minutes, diversion by 55%, and patients who left without being seen by 28%.