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Case Study 3


Following the relocation of the Paediatric Assessment and Observation Unit (A&O) from the Emergency Department (ED) to ward G5 in 2007 (due to staffing pressures), the hospital had been experiencing significant problems with the transfer of children from ED to A&O. In addition long waiting times for a decision to admit or discharge patients were occurring and due to capacity issues, A&O was often full with patients waiting in the G5 playroom.  The situation was becoming stressful for the children, parents and staff.

Therefore improvements were required to:
  • Streamline the flow of patients from the Emergency Department to A&O.
  • Reduce the time taken for a decision (admit or discharge) after arrival in A&O.
  • Ensure that capacity is used to its best advantage by reducing the number of inappropriate discharges.
  • Improve the work environment for staff.
SimLean Facilitate

Day 1 of the improvement workshop was spent with staff on the wards mapping the process using a proforma for data collection.  The proforma requires data regarding identification of each 'process step' in sequence complete with information regarding the 'touch time', 'flow time' and percentage 'yield' (i.e. how frequently does the process occur in this way and how often does flow get interrupted at each process step).  Next staff mapped the process on brown paper using post-it notes and calculated the cumulative yield of the process.  Whilst the staff involved in improving the process used various tools to consider how to improve patient flow and maximise 'value' the research team used the data to convert the process map into a model using SIMUL8 software.  The following day staff were shown the model complete with their own data and watched how patients and staff were moving (or not!) through the process.


The visual representation of the process map using the SIMUL8 software was very engaging.  Many felt that this representation facilitated ideas regarding improving the patient pathway and reducing variation in the process.  A scenario was tested using the model to explore the impact of 'protecting a bed' for certain types of paediatric admissions.