Lean Healthcare Approach With Fast Track: Standardized Work in Emergency Services

Introduction

Overcrowding in emergency departments is a serious public health problem affecting the quality of emergency care and clinical decisions about admission. (Jung et al., 2021). The increasing use of emergency departments as the first contact for health is a multifactorial issue on a global scale (Heymann et al., 2019). Emergency departments have had an increasingly growing demand for health care, and efforts to ensure quality patient care have been widely documented in specialized literature (Chaves, 2022).

Emergency departments have become increasingly crowded, which congested access to health services due to a rise in demand, the blocking of access to these types of services, and, paradoxically, an improvement in clinical capacity in emergency departments (Ahsan et al., 2019). This increase in clinical capacity of emergency departments is a result of technological advances related to care and administrative techniques. Although paradoxical, as many vacancies emergency departments have, as much they will be demanded by the population.

In Brazil, universal, equal, and orderly access to health actions and services begins with the Unified Health System (Sistema Único de Saúde – SUS) and is later fulfilled within the regionalized and hierarchical network, according to the complexity of the service.

In Brazilian health care network, that are 24-hour Emergency Care Units, called 24-hour UPA, that will be mentioned in this chapter as 24h ECU, are in charge of providing care of intermediate complexity, and – articulated with primary care units, the mobile emergency care service (SAMU 192), home care and hospital care – aim to contribute to improving the operation of the Emergency Care Network (RAU) (Brazil, 2021).

Brazilia 24h ECU are structures of intermediate complexity between the primary health units and the hospital network. They operate 24 hours a day, every day of the week, and compose an organized network of urgent and emergency care, with previously defined pacts and flows, to guarantee the reception of patients, intervening in their clinical condition, and referring them to the other points of attention of the health care networks, providing continuity of treatment with a positive impact on the individual and collective health of the population (Brasil, 2021).

The relationship between the supply of emergency departments and their demand has been studied through numerous indicators that aim to improve care in the management process. Studies on the metrics used in healthcare to assess the effectiveness of the provision of services have been studied by several authors over the last few years. The indicators most used are the length of stay (LOS) and the left without being seen (LWBS), which are of great importance for managers to assess the performance of emergency departments in regards to overcrowding (Chaves, 2022).

Reducing the LOS of low-risk patients is one of the main contributions of the Lean approach. Healthcare with the Fast-Track method reduces emergency room overcrowding due to the agility of care for patients who require the simplest resources and are performed first. It should also be considered that overcrowding in emergency departments contributes to the increased rates of patients who leave without being seen (LWBS). These patients tend to return to emergency departments in more severe conditions. Therefore, the Lean Healthcare approach and the Fast-Track method, in addition to reducing overcrowding, also reduce mortality rates (Chaves, 2022)

The idea of processes and systems must be expanded beyond the company’s physical space. It is not enough to be efficient in this environment if the activities that support and add to the products produced do not follow at the same pace. “The lean and standardized model encompasses a company in its entirety, from the source of resources to the consumer and the return of a new purchase order” (Pompeu et al., 2015, p.4).