Value Stream — Emergency Department
Current-state map of an emergency department running 320 patients a day, computing the 6.7-hour lead time against 93 minutes of clinical work and naming imaging as the capacity constraint.
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title "Emergency department — current state"
supplier "Walk-in + ambulance arrivals"
customer "Admitted or discharged patients" demand: 320/day
available 24h/day # the department never closes
control "Bed board (EPR)"
process Triage { ct: 6m; uptime: 98%; operators: 2; shifts: 3; fpy: 96% }
wait 34m # queue for a cubicle
process "Doctor assessment" { ct: 18m; uptime: 92%; operators: 4; shifts: 3; fpy: 88% }
inventory 14 patients # converted to time at takt
process "Bloods + imaging" { ct: 42m; uptime: 80%; operators: 3; shifts: 2; fpy: 93% }
wait 1h20m # waiting on radiology reporting
process "Senior review" { ct: 12m; uptime: 90%; operators: 2; shifts: 2; fpy: 91% }
wait 2h10m # waiting for a ward bed
process "Discharge or admit" { ct: 15m; uptime: 95%; operators: 2; shifts: 3 }
info "Ambulance pre-alert" from supplier to Triage electronic
info "Bed request" from "Senior review" to control electronic
info "Ward allocation" from control to "Discharge or admit" manual