Date on Master's Thesis/Doctoral Dissertation


Document Type

Doctoral Dissertation

Degree Name

Ph. D.


Industrial Engineering

Committee Chair

Holman, Grady T.

Committee Co-Chair (if applicable)

Depuy, Gail W.

Author's Keywords

Process improvement; Admissions; Work flows; Patient safety; Prospective; Process mapping


Hospitals--Admission and discharge; Children--Hospitals--Administration


Delays in healthcare process pose problems in hospitals today (Lane, Monefeldt, & Rosenhead, 2000; Horwitz & Bradley, 2009; Stone, Boehme, Mundorff, Maloney, & Sriastava, 2010). These delays create risk for patient by preventing timely delivery of care. The purpose of this research was to evaluate the Admission Express Unit (AEU) of Kosair Children's Hospital (KCH) for potential areas for improvement to aide in decreasing the amount of time required for patients to be processed through the unit. This research was a prospective study using direct observations from both the patient's point of view and the nurse's point of view. Also, one-on-one interviews were performed with doctors, nurses, nurse managers, and administrators who work in or with the AEU to gain a complete understanding of the process. From this research, several observations were made about the AEU that identified some of the issues related to increased amount of time for patients to travel through the system. First, it was discovered that 37% of the deviated events or failures, which resulted in delays, were found in the Nurse Assessment step. Secondly, it was discovered that the Intake Process had the highest average time to recover from delays, averaging 32 minutes. Thirdly, it was discovered that, according to the staff and personnel of the AEU, there are five problematic process steps, out of approximately thirty, in the AEU process: 1) Patient Pre-Arrival Work, 2) Patient Roomed AEU, 3) Physician Arrives, 4) Make/View/Receive Orders, and 5) Call Report to Floor. Next, it was discovered that of the five problems identified by the staff and personnel, three of the problem areas are dependent on one another; Patient Pre-Arrival Work, Physicians Arrives, and Make/View/Receive Orders. Finally, it was discovered that the Call-in/Patient Pre-Arrival Process is the most important process of the AEU relative to the amount of time patients spend in the unit because it is the first step the patient incurs. If it does not go smoothly the remaining processes are affected. Also, the remaining process steps cannot be executed until the Call-in/Patient Pre-Arrival Process is successfully completed. From these findings, a list of recommendations was created to provide to Kosair Children's Hospital that could potentially assist in improving the AEU process. First, the AEU needs to identify one point of contact for the primary care physicians to call to admit patients. Also, whoever the contact person is, they need to develop an intake form that, when completed, contains the necessary patient information while identifying the acuity of the patient. Secondly, it is recommended that KCH train its new residents each year in the policies and procedures of the AEU so that each resident is aware of such things as the ability to decline and refer a patient to the emergency department based on acuity and the 15 minute time limit to see each patient upon arrival to the AEU. Thirdly, the AEU needs to reevaluate their policies and agree that consultations and most treatments will be performed in the patient's room in the general medical and surgical care areas and not in the AEU. Finally, it is recommended that the AEU not be used as an area for teaching new residents as the AEU is an express unit and the teaching of the residents only delays the process of getting patients in and out.