IDENTIFYING WASTE USING VALUE STREAM MAPPING TO ACCELERATING PATIENT FLOW: A CASE STUDI IN EMERGENCY DEPARTMENT OF RSUD Dr MOEWARDI

Nurul, Jannatul Firdausi, Trisasi, Lestari, Kuncoro, Harto Widodo

Abstract


Background: Overcrowding is a serious problem in many hospital. This condition have
become global and public health problems. Spending long time to wait in ED causes queuing
of patient and delaying proces of services. Emergency Department (ED one of foremost
services in hospital that often faces the queuing problems. Abnormal queuing of patient
causes work process very busy, appearing many problems and making medical and non
medical staffs not comfortable to work. Inefficient of queuing will have impact for hospital
services widely, such as quality, safety of services and hospital financial. The leader must be
aware and do mitigation to increase queuing efficiency in hospital. The study aimed to
understanding waste during patient treatment in emergency department until admission to
inpatient unit.
Method: The study was exploratoris case study, single cases embedded design. This research
canducted by non participatory observation. Study was conducted in Emergency Department
RSUD Dr Moewardi and involved 45 internal patient in ED. Dala collected were quantitative
and qualitative data. Quantitative was conducted by observation waiting time patient in ED
who waited availability of inpatient bed and. Quantitative data interpreted by value stream
mapping. Qualitative was conducted by indepth interview about influencing factors of EDInpatient
process tha contributed delaying patient transfer.
Result: The main findings of this study (1). Waiting time patient in Emergency Department
exceed of standard (< 3 hours). Total treatment time from patient arrival until delivered to
inpatient room 3 hours 6 minutes 33. (2) The most occurred waste during patient treatment in
emergency department until delivering to inpatient unit were waste of waiting. (3) Wasting
time in ED caused multiple factors such as limited resources (human and tools), lack of
coordination and communication between staff or department, hospital management system
did not used optimally, problem of tool’s layout and worked in fragmented department (no
cross functional team work) (4) Implementation clinical cell and pull on process will increase
value added of patient flow 50,4%.
Conclusion: Limited resources and lack of relation inter provider or department as main
bottleneck of increasing waiting time in ED.
Keywords: Waste, Value Stream Mapping, Patient Flow


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