Efficiency of Emergency Services Through the Application of Value Stream Mapping as a New Approach to Overcrowding

Many hospitals worldwide grapple with overcrowding in their Emergency Departments (EDs). In an effort to enhance efficiency, the Lean philosophy has emerged as a solution, focusing on waste reduction, process improvement, and augmentation of value-added activities. One noteworthy Lean technique is Value Stream Mapping (VSM), which outlines specific changes to create an ideal future state. An illustrative case involves vertigo caused by Benign Paroxysmal Positional Vertigo (BPPV), a common syndrome significantly impacting patients’ quality of life. Despite evidence-based practices, a substantial number of BPPV patients do not promptly undergo assessment and treatment. To improve the management of patients with BPPV in the ED at Amato Lusitano Hospital (Castelo-Branco, Portugal) through the application of VSM, an exploratory and analytical study of a small random sample of cases was made. The Lean VSM methodology was applied to the clinical environment. A comparative analysis of the steps, procedures, and times between the current state and the future state map was carried out. The application of VSM concepts has led to a reduction in the total time that a patient takes between admission to the ED and clinical discharge, a reduction in staff needed during the process and a reduction of complementary diagnostic tests. Applying this methodology, it seems to be possible to increase the efficiency of the BPPV assessment process in the ED, with potential improvement in diagnosis, treatment, and patient satisfaction, as also as health gains.