Abstract
BACKGROUND: In emergency departments (EDs), long wait times and overcrowding are major challenges, worsened by the pandemic's increased patient volumes and demands. Lean methodology could offer a structured approach to reduce inefficiencies, improve care quality, and support nursing staff. AIM OF THE STUDY: This study aims to evaluate the impact of applying a Lean approach to optimize emergency nursing care post-pandemic within an ER setting. METHODS: This study utilized a mixed-methods design in the ER of a private hospital in Egypt. Data collection involved three Lean tools: the voice of the process observation sheet, which tracked the journeys of 100 patients; voice of customer structured interviews, conducted with 90 patients to assess satisfaction with waiting times; and voice of business interviews, held with 64 staff members to evaluate satisfaction with available resources. Additionally, a cause-and-effect analysis was conducted and summarized in an A3 report, identifying key factors contributing to extended wait times. RESULTS: The average wait time in the emergency department was 157.87 min, making up 77.7% of the total length of stay. The consultation phase accounted for the longest delays, with an average wait of 92.46 min. Patient satisfaction with waiting times was moderate (61.74%), while staff satisfaction with resources was higher (71.09%), but only 53.1% were satisfied with patient wait times. Key causes of delays included non-compliance with triage protocols (95.0%), lack of care pathways (90.3%), and insufficient bed capacity (83.1%). An A3 report proposed strategies to reduce wait times and enhance satisfaction. CONCLUSION: This study highlights waiting times as a major challenge in EDs, significantly impacting service quality, patient outcomes, and nursing staff workload. Lean-based strategies, such as standardized triage and improved care pathways, are essential to reducing delays and enhancing both patient care and staff satisfaction in the post-pandemic healthcare environment.