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Using LEAN to Improve a Segment of Emergency Department Flow

Vose, Courtney MBA, MSN, RN, APRN, NEA-BC; Reichard, Christine CHUC; Pool, Susan; Snyder, Megan BSN, RN, CMSRN; Burmeister, David DO

JONA: The Journal of Nursing Administration: November 2014 - Volume 44 - Issue 11 - p 558–563
doi: 10.1097/NNA.0000000000000098
Departments: Spotlight on Quality

Emergency department (ED) overcrowding is an organizational concern. This article describes how Toyota LEAN methods were used as a performance improvement framework to address ED overcrowding. This initiative also impacted “bolus of patients” or “batching” concerns, which occur when inpatient units receive an influx of patients from EDs and other areas at the same time. In addition to decreased incidence of overcrowding, the organization realized increased interprofessional collaboration.

Author Affiliations: Administrator, Patient Care Services (Ms Vose); Administrative Partner, Patient Care Services (Ms Reichard); Systems Analyst, Care Continuum (Ms Pool); Director, Patient Care Services (Ms Snyder); Chair, Department of Emergency Medicine (Dr Burmeister), Lehigh Valley Health Network, Allentown, Pennsylvania.

The authors declare no conflicts of interest.

Correspondence: Ms Vose, Rte 22 and Schoenersville Rd, Bethlehem, PA 18017 (

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