ABSTRACT
This chapter discusses lean flow in relation to emergency department (ED) psychiatry. It focuses on the impact of "long-stay" patient on ED operations. Lean flow was originally used to describe movement of parts in the Toyota Production Company. Healthcare is a bit different than a factory because, for the most part, value is not found in a tangible product. So, the concept of lean healthcare is moving a patient from one value-added activity to another with minimal wait unless the patient needs therapeutic time for healing. The chapter provides steps to improve poorly functioning queues within emergency psychiatry: Reduce server utilization: reduce the rate of arrivals, and increase the rate of service; and Reduce variation: reduce the variation in arrivals, and reduce the variation in service. The number of emergency psychiatric patients is increasing nationally with dwindling outpatient and inpatient services. These patients have a disproportionate impact on ED because of the much longer length of stay than medical patients.
