Lean Emergency Department Operations

ED improves door-to-doc time by 42 percent with
PerformNext™ Lean Operations


Despite a recent expansion, Catholic Health System (CHS) Main Street Campus’ ED waiting room was consistently overcrowded. In addition, the closure of a nearby emergency department meant an expected increase in volume of 7,000 patients annually.

The need for change was essential. CHS developed a strategy to optimize their ED with lean concepts:

  • Lean experts Drs. Jody Crane and Chuck Noon completed an in-depth analysis of issues impacting patient flow.
  • The CHS team participated in a Lean ED Operations Workshop to learn lean concepts and their practical application.

The curriculum and analysis gave CHS leaders a strong foundation to implement lean strategies and restructure the department. Some of these changes included the following:

  • CHS created a Fast Track (FT) to address the large percentage of low acuity patients.
  • A rapid triage process (1-2 minutes) and direct bedding with bedside registration was implemented.
  • A results waiting area was created for patients who were waiting for lab and radiology results, allowing beds to be utilized more efficiently.

The restructuring of the ED delivered compelling and sustainable results. The highly-efficient FT cut the LWOBS in half and emptied the 70-person waiting room, which was repurposed for another department. Overall, CHS achieved commendable results, including improving LWOBS, door-to-doc times and length of stay.
Catholic Health System

Catholic Health System

Location: Buffalo, N.Y.
ED: 34,000 APV
T-System Solution: PerformNext™ Lean Operations

PerformNext™ Lean Operations Results: Despite about 14% volume increase:
  • LWOBS rate cut in half
  • Door-to-provider time reduced by 42.3%
  • T&A LOS reduced by 14.5%
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