Get Well Sooner
University of Pittsburgh Engineers Collaborate with Children’s Hospital of Pittsburgh of UPMC to Reduce Emergency Room Wait Times
PITTSBURGH (January 3, 2018) … One of the few places more nerve-wracking for a parent with a sick child than the emergency room is the waiting room outside the emergency room. Rushing to the hospital only to sit and wait can increase
anxiety and worry, especially with new parents.
“I’ve seen firsthand some patients whose total time in the emergency department was quite long, and during our busiest times, three hours or more of their time was in the waiting room,” says Anna Svirsko, a third-year graduate student studying industrial engineering at the University of Pittsburgh.
Svirsko is part of a team of industrial engineers at Pitt’s Swanson School of Engineering who partnered with Children’s Hospital of Pittsburgh of UPMC to create a “Wait Time Indicator” and help patients and their families in the Emergency Department (ED) at Children’s Hospital estimate when a doctor will be ready to see them. The indicator is part of a larger project to reduce overall patient length of stay in the ED.
“The indicator uses the average wait time over the past hour and the number of people currently in the waiting room to predict how long it will take until the next exam room will open,” says Louis Luangkesorn, assistant professor of industrial engineering at Pitt and faculty advisor to the students working at Children’s Hospital.
Wait times are updated every three minutes and displayed in the ED waiting room as well as on Children’s Hospital’s website. In recent years, Children’s Hospital has seen an influx of patients, encouraging leadership eager to find a cure for the crowds.
“We’ve seen a steady increase in our yearly patient volume nearly each of the past 15 years,” says Richard Saladino, MD, chief of pediatric emergency medicine at Children’s Hospital. “I think the new generation is becoming more informed and seeking medical care more often and at a lower threshold in recent years.”
Children’s Hospital serves people from western Pennsylvania as well as Ohio and West Virginia. Unexpected spurts of patients can quickly cause the ED to become overcrowded and understaffed. Removing uncertainty encourages patients to stick around for treatment, or choose alternatives forms of care provided by Children’s Hospital, such as Children’s Express Care centers.
“Families who become frustrated with a long wait will occasionally leave without being seen by a doctor if they don’t have a sense of when they will be seen,” says Dr. Saladino. “Perceived wait time is much different than actual wait time and therefore, being upfront with expectations can have a big impact on patient experience.”
The underlying data behind the Wait Time Indicator is capable of predicting days or even hours when the ED can expect to see many patients. These “surge times” and staffing information are incorporated into another tool that can help guide clinicians on predicting when the ED will be busy, allowing them to call in more doctors.
“The surge tool can identify a surge around two hours before it hits its peak. In the past, additional doctors usually wouldn’t arrive until after the peak and the crowd had already started to thin. Now, we can better anticipate the rush,” says Dr. Luangkesorn.
Pitt students began working with the ED at Children’s Hospital when former associate professor Bryan Norman directed senior design projects to help solve hospital problems. The students started treating the ED’s ailments by using workplace efficiency techniques and strategies they were learning in their classes.
“They started with semester-long projects, which were worthwhile experiences but limited in terms of what you could accomplish,” says Dr. Luangkesorn. “Children’s Hospital wanted to expand its relationship with Pitt Engineering to work on bigger problems.”
Dr. Luangkesorn and other members of the Industrial Engineering faculty started actively recruiting students from their classes to work at Children’s Hospital. Over the past three years, about 15 to 20 students have been involved with projects aimed at reducing wait times, optimizing staff efficiency, increasing resource utilization and creating a better environment for patients.
“The general goal of working with Children’s Hospital is to reduce treatment times and improve patient experience,” says Jayant Rajgopal, professor and graduate program director in the Department of Industrial Engineering at Pitt. “We started with a customer satisfaction approach to improving patient satisfaction at the hospital. We surveyed the patients, and one major complaint was that wait times were too long.”
Now the Pitt industrial engineers attend weekly meetings with the ED doctors and staff. They are members of the Children’s Hospital Emergency Department Length of Stay Task Force.
“We were invited to be a part of the Task Force about two years ago,” says Dr. Rajgopal. “We have a whole team of people committed to the ultimate goal of reducing overall length of stay in the emergency room—without compromising quality treatment.”
The Pitt team has also introduced new strategies to prepare the Children’s Hospital staff for the urgency of an emergency. They implemented the “5S” methodology for organizing equipment. The “S-es” stand for “sort, set in order, shine, standardize, and sustain” and were originally part of a Japanese business principle that helped enable lean or “just-in-time” manufacturing.
Students worked with the Environmental Services staff to improve how quickly rooms are cleaned, when previously Children’s Hospital staff members consulted a central computer to find which rooms needed cleaning. They now use iPads on the cleaning carts that give them updates on the move, saving back-and-forth trips to the stationary computer. “Cleaning faster means those rooms are available for the next patient sooner,” adds Svirsko.
“The Wait Time Indicator is just one project of many,” says Dr. Luangkesorn. “Children’s Hospital has decreased average time to rapid triage by almost 70 percent, getting the patients in most immediate need of attention more quickly in front of a doctor. We’ve reduced average length of stay for all patients over the past few years, too, and we expect to keep getting better as more students get involved.”
Contact: Paul Kovach