# Streamlining emergency nursing care post-pandemic: A lean approach for reducing wait times and improving patient and staff satisfaction in the hospital

## TL;DR

This study uses Lean methods to reduce wait times and improve satisfaction in emergency departments after the pandemic.

## Contribution

The study applies Lean tools to identify and address inefficiencies in emergency nursing care post-pandemic.

## Key findings

- Average ED wait time was 157.87 minutes, with consultation being the main bottleneck.
- Non-compliance with triage protocols and lack of care pathways were key causes of delays.
- Lean strategies like standardized triage can improve patient and staff satisfaction.

## Abstract

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.

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.

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.

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.

The online version contains supplementary material available at 10.1186/s12912-025-02759-w.