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Design of the emergency service production in a public hospital

For a major public hospital in Santiago we did a design for the Emergency service production, including its implementation, which we synthesize here. Analyzing the data of production and performance of the hospital´s Emergency Department we concluded that patients classified as M2 and M3 by a Triage use more than 90% of the use of resources. Therefore, the design focuses on these patients, since they are also a priority due to the severity of their condition. To order the workflow, which was mixed and confounded with the rest of the patients, production lines were segregated for the M2 and MC3 patients. For such lines to be orderly and logical, the physical space was remodeled by means of an architecture project. This resulted in a well-defined workflow in which patients go through locations, identified by signals, where well specified medical actions are performed and governed, in some cases, by medical protocols. Then they go from one step to the following under well-defined criteria and their situation is known at all times. This makes a huge difference in terms of physical organization; elimination of delays due to "loss" of patients, ensuring that the most seriously ill patients are perfectly identified and have no risk of delayed attention; and better and more effective use of the time of doctors and nurses, including better coordination with exams services. Theory and international experience support such design, since specialization is favored by concentrating a group of professionals in situations with less variety, facilitating coordination and increasing productivity. In a similar approach an important hospital such as the one of Stanford University decided to implement split flows in its emergency in order to accelerate the flow and increase productivity 3. New workflows were implemented in June and July 2017. Comparison of patients' LOS from July to August, shows a decrease after implementation of about 20 % and with a decreasing tendency. Also a comparison with 2016 same months was made showing up to 50% reduction. But most important, Emergency Department professionals, who were reticent at the beginning of the implementation, were quickly convinced that the flow provided more order and helped them in their work. In addition to the design of the flow, protocols were developed for medical treatment of the most frequent disease, in this case Cardiology, establishing which medical variables to measure, with tests and actions to execute according to their values. Cardiology Protocol was successfully implemented. Also, flow support services, such as exams and inter consulting, have been improved to reduce service time and avoid delays in the flow.



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