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In healthcare, a value-added activity is any activity that moves a patient closer toward resolving his or her medical need. It is an activity that, if reduced or eliminated, would result in a decrease in the quality of care. In this view, all other activities are considered non-value added to the patient. Activities such as an examination by a provider, a physician or nurse procedure, such as a laceration repair, or a diagnostic test are clearly value added. Non-value-added activities would include transportation, registration, and waiting. The concept of “lean flow” (derived from the Lean management methodology) means moving a patient from one value-added activity to the next with minimal delay in between.

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For the patient, there are clear benefits associated with lean flow.1 Prompt assessment and treatment can minimize the risk of an “adverse event” or further health deterioration. Pain management, for example, is easier and more effective when started as soon as possible. In addition to the clinical advantages, the sooner a patient can be seen by a medical professional, the sooner the patient can be moved from an anxious state to one that is less stressful. For example, the parents of a febrile infant will remain anxious until a physician can evaluate their child and render a diagnosis. Lean flow also has the effect of minimizing the length of stay and thereby reduces the opportunity costs for the patients and their family members in terms of lost work or disrupted schedules.

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For the ED staff and physicians, lean patient flow results in less waste. For example, the longer a patient must wait to complete treatment, the more requests for services will be generated for the nursing staff. Long turnaround times for ancillaries or other service providers in the system can extend the ending time of a physician's shift. Another form of waste occurs whenever a healthcare worker is idle. In contrast to a manufacturing operation that can keep workers busy by building inventory, a service operation cannot recover productive time that is lost because of resources being idle, awaiting more work. For example, suppose a physician is covering 8 beds but all of the bedded patients are either waiting for diagnostic results or waiting for others in the system such as nurses or technicians. Even if there are patients in the waiting room who need the services of the physician, he or she is unable to treat them because of a lack of lean flow.

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Lean flow also has the advantage of requiring fewer treatment spaces. Too often in EDs with poor flow, “treatment” spaces are used as “holding” spaces. Hence, poor flow and its accompanying long length of stays can have 3 very negative effects:

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  • First, it can result in costly capital expansions by wrongly appearing to be a “space constraint” when, in fact, it is a flow problem.
  • Second, by requiring more treatment spaces than really necessary, it can ...

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