Implementing Lean Methodology to Decrease Wait times in a Psychiatric Emergency Department

Authors

Kristina S. Baxter, University of Texas Health Science Center at HoustonFollow

Author Biographical Info

Kristina Baxter is a dedicated nursing professional with over eight years of diverse clinical experience spanning critical care, behavioral health, home health, detox, and triage nursing. After earning her Bachelor of Science in Nursing (BSN), Kristina built a strong foundation in high-acuity and community-based care, serving in both hospital and remote settings.

Her commitment to quality and systems-level improvement led her to complete her Doctor of Nursing Practice (DNP) at UTHealth Houston, where she focused her scholarly work on optimizing psychiatric emergency department operations through Lean methodology. Throughout her career, Kristina has been passionate about improving access to timely mental health services, enhancing interdisciplinary collaboration, and streamlining clinical workflows to reduce delays and improve outcomes.

As a lifelong learner and advocate for evidence-based practice, Kristina remains dedicated to driving innovation in nursing practice and advancing mental health care delivery across diverse settings.

Date of Doctor of Nursing Practice Project Completion

Spring 5-2-2025

Faculty Advisor

Dr. Latarsha Cheatham

Abstract

Purpose

This quality improvement project aimed to implement Lean strategies to optimize the intake process in a psychiatric emergency department, thereby reducing patient wait times, minimizing left-without-being-seen (LWBS) occurrences, and improving access to timely psychiatric care.

Background

The project was conducted in a hospital-based psychiatric emergency department in Southeast Texas, serving adults and children six years and older.

Methodology

Lean methodology and PDSA cycles were employed to refine the intake process and eliminate inefficiencies. Key interventions included patient transport by technicians to minimize delays, using tele-clinicians for assessments to reduce staff burden, and restructuring nursing assessments to prioritize telehealth consultations (Dr. Says) before EMR documentation, enabling quicker provider decision-making. Technicians were also assigned data entry tasks, allowing nurses to focus on clinical tasks. Time studies were conducted before and after the interventions. The sample size included 1,272 patients seen during these periods.

Results

Findings revealed a 61% reduction in wait times, from an average of 280 minutes to 108 minutes, with no LWBS occurrences post-intervention. Results demonstrated that applying lean strategies to streamline workflow and enhance efficiency is effective, with potential for broader application in high-volume psychiatric EDs.

Implications

Lean methodology offers a valuable opportunity to strengthen psychiatric ED operations, improving workflow and patient care. This project highlights that Lean, through telehealth, expanded technician roles, and restructuring assessments, can reduce inefficiencies in psychiatric EDs. Ongoing monitoring and process adjustments are crucial to maintain improvements. Future steps include expanding the model to other departments and refining workflows.

Keywords

Lean Methodology, Emergency Department, Psychiatry, Mental Health, Wait times, Clinical Workflow Improvement, Quality Improvement

Recommended Citation

Baxter, Kristina S., "Implementing Lean Methodology to Decrease Wait times in a Psychiatric Emergency Department" (2025). Doctor of Nursing Practice Final Project Abstract. 62.
https://digitalcommons.library.tmc.edu/dnp_abstract/62