Effective management of patients with acute ischemic stroke based on lean production on thrombolytic flow optimization

Abstract

The efficacy of thrombolytic therapy for acute ischemic stroke (AIS) decreases when the administration of tissue plasminogen activator (tPA) is delayed. Derived from Toyota Production System, lean production aims to create top-quality products with high-efficiency procedures, a concept that easily applies to emergency medicine. In this study, we aimed to determine whether applying lean principles to flow optimization could hasten the initiation of thrombolysis. A multidisciplinary team (Stroke Team) was organized to implement an ongoing, continuous loop of lean production that contained the following steps: decomposition, recognition, intervention, reengineering and assessment. The door-to-needle time (DNT) and the percentage of patients with DNT ≤ 60 min before and after the adoption of lean principles were used to evaluate the efficiency of our flow optimization. Thirteen patients with AIS in the pre-lean period and 43 patients with AIS in the lean period (23 in lean period I and 20 patients in lean period II) were consecutively enrolled in our study. After flow optimization, we reduced DNT from 90 to 47 min (p < 0.001). In addition, the percentage of patients treated ≤60 min after hospital arrival increased from 38.46 to 75.0 % (p = 0.015). Adjusted analysis of covariance confirmed a significant influence of optimization on delay of tPA administration (p < 0.001). The patients were more likely to have a good prognosis (mRS ≤ 2 at 90 days) after the flow optimization (30.77-75.00 %, p = 0.012). Our study may offer an effective approach for optimizing the thrombolytic flow in the management of AIS.

How a CT-Direct Protocol at an American Comprehensive Stroke Center Led to Door-to-Needle Times Less Than 30 Minutes

“…8 Meanwhile, a second study saw significantly decreased median DTN times to 47 minutes, after the treatment process was enhanced by borrowing relevant principles from the automotive industry. 9 Although the achieved median DTN times in these studies were nearly 20 minutes longer than what was observed in the current study, they are a testament to the ability of process improvements to significantly decrease treatment times in acute stroke care.…”

Modeling the Impact of Interhospital Transfer Network Design on Stroke Outcomes in a Large City

“…Indeed, strategic efforts to improve individual aspects of stroke systems of care have yielded meaningful gains in overall outcomes. 6, 31, 32…”

Application of Bundle Care in Patient with Individualized Sedation Care During the Interventional Therapy for Anterior-circulation Acute Ischemic Stroke

“…In the process of individualized sedation, it is necessary to choose a reasonable medication scheme and dosage under the doctor's instructions for different individuals, and the nerve physician who qualifies for the prescription of anesthetic and the ability of intubation and ventilation should participate in the supervision. In this research, the medical cooperation was good, and the time from entry into the operating room to recanalization in both groups was lower than the reference level reported in the literature [12][13][14]. Meanwhile, the incidence of adverse reactions was low and there was no intraoperative death.…”