Patients flow optimization in ED: An operational research on the impacts of physician triage

Abstract

Emergency Departments (ED) face chronic issues such as longer length of stay and decreased quality of care. These organizations have developed the use of Lean manufacturing techniques to improve patients flow. Adaptations of Lean in healthcare almost systematically return positive results and negative potential effects are underestimated. We use the still debating issue on whether a physician should take part of the triage to explore the pros and cons of a Lean technique in healthcare. We show that triage physicians impact “low-severity” patients length of care and do not impact inpatients one. We also show that physician triage is associated with a higher length of triage that can create a waiting lines before the triage operation. We discuss these results by showing that the decision to implement Lean techniques should be taken considering a risk / benefits trade-off, which is hardly the case actually.