Implementing Lean Methodology to Decrease Wait times in a Psychiatric Emergency Department

Purpose This quality improvement project aimed to implement Lean strategies to optimize the intake process in a psychiatric emergency department, thereby reducing patient wait times, minimizing left-without-being-seen (LWBS) occurrences, and improving access to timely psychiatric care. Background The project was conducted in a hospital-based psychiatric emergency department in Southeast Texas, serving adults and children six years and older. Methodology Lean methodology and PDSA cycles were employed to refine the intake process and eliminate inefficiencies. Key interventions included patient transport by technicians to minimize delays, using tele-clinicians for assessments to reduce staff burden, and restructuring nursing assessments to prioritize telehealth consultations (Dr. Says) before EMR documentation, enabling quicker provider decision-making. Technicians were also assigned data entry tasks, allowing nurses to focus on clinical tasks. Time studies were conducted before and after the interventions. The sample size included 1,272 patients seen during these periods. Results Findings revealed a 61% reduction in wait times, from an average of 280 minutes to 108 minutes, with no LWBS occurrences post-intervention. Results demonstrated that applying lean strategies to streamline workflow and enhance efficiency is effective, with potential for broader application in high-volume psychiatric EDs. Implications Lean methodology offers a valuable opportunity to strengthen psychiatric ED operations, improving workflow and patient care. This project highlights that Lean, through telehealth, expanded technician roles, and restructuring assessments, can reduce inefficiencies in psychiatric EDs. Ongoing monitoring and process adjustments are crucial to maintain improvements. Future steps include expanding the model to other departments and refining workflows.