Investigate the parameters which affect the patients waiting time in emergency department of orthopedic services in Ayatollah Kashani hospital with the lean management approach

Introduction: In the new age, human health is at risk more than any other time. Hospitals play an important role in restoring health to the people. The emergency department provides the patients who are damaged in an accident or their illness has worsened suddenly with emergency medical care and diagnostic services. In the emergency department every single second counts. The proper management of the patients waiting time requires identifying the parameters which affect increasing the waiting interval and “lean management” is one of the tools for identifying these parameters and optimizing the process of serving patients. This study aimed to investigate the parameters which affect the patients waiting time in emergency department of orthopedic services in Ayatollah Kashani hospital with the lean management approach. Methods: This study was a descriptive and mining survey. Population survey consisted of patients in the emergency department of Ayatollah Kashani hospital for orthopedic services in the summer. In order to create a simulation model, the required data have collected from 60 patients entered for orthopedic services in the last week of June and the first week of July (The sample size was determined according to a formula). The data collected by some forms and was processed using “EASY FIT” software. Data collection forms were collected by the researchers was designed and its validity was confirmed by professors and experts concerned. Containing these forms include patient arrival time, start time and the end of the orthopedic service. Then the value stream map was drawn on the basis of lean management principles. On the next step the existing waste was identified and some approaches for eliminating the waste were suggested. Finally the model simulated by “SIMUL8” software and the influence of the applied approaches on the average time of the patient presence was investigated. Results: Regarding to different kinds of waste in orthopedic services, the total waste identified was 30 and 16 approaches were suggested to eliminate them. The output result of applying the approaches 4(Embed a closed operating rooms (stock)), 5 (implementation of (5s)) and 14 (using single minute exchange of die technique (SMED)) in order to receive services, orthopedics average patient stay of 139 minutes to 118, 121 and 131 declined .simultaneous implementation of the three strategies to implement the results showed that the average time a patient in the emergency 139 minutes to 95 minutes reduced. Conclusion: The results show we can eliminate a lot of waste in the process of providing orthopedic services with low costs. In order to do that, we should use scientific methods such as lean management techniques to improve the processes. To achieve the objective mentioned above the decision makers and health managers should be familiar with these techniques and provide practical methods in the field of health and medical care. Key Words: Emergency Service, Hospital; Orthopedics; Computer Simulation.