HYBRID EVENT: You can participate in person at Baltimore, Maryland, USA or Virtually from your home or work.

8th Edition of Nursing World Conference

October 17-19, 2024 | Baltimore, USA

October 17 -19, 2024 | Baltimore, USA
NWC 2018

Bejoy Chacko

Speaker at Nursing Conference - Bejoy Chacko
Hamad Medical Corporation, Qatar
Title : Implementing lean principles to reduce the registration to disposition time in emergency department, Hamad general hospital


Background: Hamad General Hospital-Emergency Department is one of the busiest in the world with over 1400 registrations per day. As any other ED, we face the same issues of increased length of stay, increasing number of left without being seen patients, increasing pending admissions, etc. The median waiting time in ED is over 5hrs from registration to disposition. These wait times are mainly due to complex patient flow and triage process. The percentage of Left without being seen cases were also increasing.

Aim: To reduce the registration to disposition time in Emergency department of HGH by 50% through the implementation of lean principles by the end of Jan 2017.

Methodology: We Implemented the Lean principles to identify the waste in the system. We plotted a detailed process mapping to identify the current process and to recognize non value added steps. Removed all non-value added steps from the process and trailed the new process using focus PDSA. Implemented four PDSA that are 1) eye ball screening (Sieving) at registration, 2) designated area for each category of patients, 3) developed specific task group for triaging to reduce variation in performance.

Result: The purpose of triage in the emergency department (ED) is to prioritize incoming patients and to identify those who cannot wait to be seen. Through implementation of Lean principles, we are able to reduce the registration to triage time from 30 min to 8 min (about 50%). It significantly reduced percentage of Left without being seen (LWBS) cases from 20% to less than 13 %. Also registration to final disposition time is markedly reduced.

Audience Take Away

  • Lean principles and application of lean principles in actual clinical setting. Will discuss the application of lean principles to reduce the registration to triage time (tRN) in Hamad medical corporation, ED.
  • Discuss the waste walk and waste elimination techniques using Lean tools.
  • Share our success story of reducing the registration to triage time from 30 min to less than 8 min (Median) and how we sustain the improvement.
  • Importance of data collection and data analysis
  • Methods to analyze and present data for improvement.


Bejoy is Act. Director of Nursing in Emergency department, Hamad General Hospital, Doha, Qatar. He holds a Bachelor’s of Science in Nursing from the Bharati Vidyapeeth University, Pune, India and Masters in Business administration (Hospital Administration) from Sikkim Manipal University, India. He also holds a post graduate diploma in Emergency Medical service from West land ambulance service, UK.

Bejoy Chacko is dedicated to the Profession of Nursing since 2002 and committed to nursing culture of excellence, the value of professionalism, quality outcomes and collaborative practice with patient/family centered care. He presented several research papers regionally and internationally. He is passionate about educating staff to grow their knowledge to better care for our patients and families.