Table 2 Muda identified during the waste...

Table 2

Muda identified during the waste analysis

Muda	Description	Examples	References
Waiting time	Wait for request and technician arrival to accept the patient, due to lack of communication	The information system does not warn the radiology technician that the ED has sent a radiological examination request, nor that the patient has arrived	(Allaudeen et al., 2017; Elamir, 2018; Verbano and Crema, 2019)
	Delays for referral	-The patient stay was prolonged by delays in referral from ED and psychiatry staff -Staff waiting for results	(Alexander et al., 2020; Cookson et al., 2011; Elamir, 2018; Verbano and Crema, 2019)
	Delays at triage	During peak hours, volume too great for one triage nurse to handle	Vashi et al. (2019)
	Wait for physician/nurse	Patients waiting for assessment	(Chiarini, 2013; Cookson et al., 2011; Mazzocato et al., 2012; Sánchez et al., 2018; Verbano and Crema, 2019)
	Wait for inpatient beds	ED patient waiting for inpatient bed availability	(Carter et al., 2012; Elamir, 2018; Vashi et al., 2019)
	Delays	-Delayed handover of updates -Delays caused by handoffs	(Alexander et al., 2020; Allaudeen et al., 2017)
Transport	Inadequate patient transportation	Patients moved from one box to another depending on staff preferences	(Sánchez et al., 2018; Verbano and Crema, 2019)
	Long transportation	Long distances between services	Cookson et al. (2011)
	Unnecessary patient transportation	Moving ED patients to separate areas for admit holding	Carter et al. (2012)
Inventory	Referrals	Following the logic first in first out for reporting of radiological examinations causes queues in ED	Verbano and Crema (2019)
	Excessive/poor inventory	-Excessive stock supply to ensure availability -Unavailable stock or out of useable date	(Carter et al., 2012; Cookson et al., 2011)
	Underutilized employee	No engagement in process redesign	Carter et al. (2012)
	Useless documentation	Multiple unnecessary patient forms	(Carter et al., 2012; Vashi et al., 2019)
	Unnecessary material	Disarray in nurses' charts	Sánchez et al. (2018)
	Batching tests	Ordering tests for more than one patient at once	Sánchez et al. (2018)
	Batching patient	-Queue at triage, radiology -Staff placing and preparing more than one patient at once	(Chiarini, 2013; Sánchez et al., 2018; Vashi et al., 2019; Verbano and Crema, 2019)
Motions	Doctor/nurse movements	-Doctor seeking nurse (or vice versa), or patients -Staff walking back and forward for the photocopier	(Cookson et al., 2011; Sánchez et al., 2018; Vashi et al., 2019)
	Patient movements	Following triage, veterans returned to waiting room even if open bed available	Vashi et al. (2019)
	Movements of administrative personnel	Lengthy distance between administrative process steps	Carter et al. (2012)
Over-Production	Unnecessary first visit	In some cases, the first visit consists only of a radiological examination request, and it is therefore useless for the patient to wait for it	Verbano and Crema (2019)
	Over-triaging	Unnecessary triage phase	Vashi et al. (2019)
	Unnecessary activity	Radiology acceptance	Verbano and Crema (2019)
	Unnecessary tests	Ordering unnecessary investigations	Cookson et al. (2011)
	Duplication of information	Recording the same information multiple times	Cookson et al. (2011)
Errors or disservices	Disservice in transportation	Many patients arrive in wrong departments or are forced to repeatedly ask for information, due to a lack of indications	Verbano and Crema (2019)
	Defects	Incorrect surgical procedure, medication error	Carter et al. (2012)
	Bed issues	No empty beds, bed occupied when not needed	Vashi et al. (2019)
	Inadequate treatment	Antibiotics for viral infection	Carter et al. (2012)
	Lack of communication	Difficulties in communicating updates	(Alexander et al., 2020; Vashi et al., 2019; Verbano and Crema, 2019)
Processing	Role confusion	No clear definition of roles and responsibilities	Alexander et al. (2020)
	No alternate processes during peak	Volume too great for available capacity	Vashi et al. (2019)
	Lack of coordination	Overlapping assessments	Alexander et al. (2020)
	Reworks	-Doctor/nurse ordering tests or medications in a fragmented manner -Reassessment of patient by several members of the staff	(Allaudeen et al., 2017; Cookson et al., 2011; Sánchez et al., 2018)
	Lack of protocols	-No standards for using hallways, for patient assignments (doctors' self-assignment of patients) -Lack of standard procedures for handoffs	(Allaudeen et al., 2017; Vashi et al., 2019)

Muda	Description	Examples	References
Waiting time	Wait for request and technician arrival to accept the patient, due to lack of communication	The information system does not warn the radiology technician that the ED has sent a radiological examination request, nor that the patient has arrived	(Allaudeen et al., 2017; Elamir, 2018; Verbano and Crema, 2019)
	Delays for referral	-The patient stay was prolonged by delays in referral from ED and psychiatry staff -Staff waiting for results	(Alexander et al., 2020; Cookson et al., 2011; Elamir, 2018; Verbano and Crema, 2019)
	Delays at triage	During peak hours, volume too great for one triage nurse to handle	Vashi et al. (2019)
	Wait for physician/nurse	Patients waiting for assessment	(Chiarini, 2013; Cookson et al., 2011; Mazzocato et al., 2012; Sánchez et al., 2018; Verbano and Crema, 2019)
	Wait for inpatient beds	ED patient waiting for inpatient bed availability	(Carter et al., 2012; Elamir, 2018; Vashi et al., 2019)
	Delays	-Delayed handover of updates -Delays caused by handoffs	(Alexander et al., 2020; Allaudeen et al., 2017)
Transport	Inadequate patient transportation	Patients moved from one box to another depending on staff preferences	(Sánchez et al., 2018; Verbano and Crema, 2019)
	Long transportation	Long distances between services	Cookson et al. (2011)
	Unnecessary patient transportation	Moving ED patients to separate areas for admit holding	Carter et al. (2012)
Inventory	Referrals	Following the logic first in first out for reporting of radiological examinations causes queues in ED	Verbano and Crema (2019)
	Excessive/poor inventory	-Excessive stock supply to ensure availability -Unavailable stock or out of useable date	(Carter et al., 2012; Cookson et al., 2011)
	Underutilized employee	No engagement in process redesign	Carter et al. (2012)
	Useless documentation	Multiple unnecessary patient forms	(Carter et al., 2012; Vashi et al., 2019)
	Unnecessary material	Disarray in nurses' charts	Sánchez et al. (2018)
	Batching tests	Ordering tests for more than one patient at once	Sánchez et al. (2018)
	Batching patient	-Queue at triage, radiology -Staff placing and preparing more than one patient at once	(Chiarini, 2013; Sánchez et al., 2018; Vashi et al., 2019; Verbano and Crema, 2019)
Motions	Doctor/nurse movements	-Doctor seeking nurse (or vice versa), or patients -Staff walking back and forward for the photocopier	(Cookson et al., 2011; Sánchez et al., 2018; Vashi et al., 2019)
	Patient movements	Following triage, veterans returned to waiting room even if open bed available	Vashi et al. (2019)
	Movements of administrative personnel	Lengthy distance between administrative process steps	Carter et al. (2012)
Over-Production	Unnecessary first visit	In some cases, the first visit consists only of a radiological examination request, and it is therefore useless for the patient to wait for it	Verbano and Crema (2019)
	Over-triaging	Unnecessary triage phase	Vashi et al. (2019)
	Unnecessary activity	Radiology acceptance	Verbano and Crema (2019)
	Unnecessary tests	Ordering unnecessary investigations	Cookson et al. (2011)
	Duplication of information	Recording the same information multiple times	Cookson et al. (2011)
Errors or disservices	Disservice in transportation	Many patients arrive in wrong departments or are forced to repeatedly ask for information, due to a lack of indications	Verbano and Crema (2019)
	Defects	Incorrect surgical procedure, medication error	Carter et al. (2012)
	Bed issues	No empty beds, bed occupied when not needed	Vashi et al. (2019)
	Inadequate treatment	Antibiotics for viral infection	Carter et al. (2012)
	Lack of communication	Difficulties in communicating updates	(Alexander et al., 2020; Vashi et al., 2019; Verbano and Crema, 2019)
Processing	Role confusion	No clear definition of roles and responsibilities	Alexander et al. (2020)
	No alternate processes during peak	Volume too great for available capacity	Vashi et al. (2019)
	Lack of coordination	Overlapping assessments	Alexander et al. (2020)
	Reworks	-Doctor/nurse ordering tests or medications in a fragmented manner -Reassessment of patient by several members of the staff	(Allaudeen et al., 2017; Cookson et al., 2011; Sánchez et al., 2018)
	Lack of protocols	-No standards for using hallways, for patient assignments (doctors' self-assignment of patients) -Lack of standard procedures for handoffs	(Allaudeen et al., 2017; Vashi et al., 2019)

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