Lean methods to improve operating room elective first case on-time starts in a large, urban, safety net medical center

Coffey, C. Edward; Cho, Edward S.; Wei, Eric; Luu, Allison; Ho, Maria; Amaya, Rodolfo; Pecson, Marie; Dalton, Florence V.; Kahaku, Deborah; Spellberg, Brad; Sener, Stephen F.

doi:10.1016/j.amjsurg.2018.05.002

Cited by 21 publications

(24 citation statements)

References 20 publications

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“…Their most common reasons for delays included surgeon delays (35.9%), equipment issues (21.5%), anesthesia delays (17.2%), and patient related factors (11.4%). 25 This is notably different from our study which demonstrated the leading causes of delayed OR on-time starts were primarily patient related factors, anesthesia, room turnover, followed by surgeon delays. The success of the Lean methodology comes from the leadership, communication, culture and education in the lean model.…”

Section: Discussioncontrasting

confidence: 95%

“…Prior studies also demonstrated a statistically significant increase in OR on-time starts following the implementation of the lean model. 25,26 The intervention in a study by Coffey et al focused on patient arrival, operative team communication, and multidisciplinary debrief. 25 Our intervention although similar did not include interventions towards patient related factors.…”

Section: Discussionmentioning

confidence: 99%

“…25,26 The intervention in a study by Coffey et al focused on patient arrival, operative team communication, and multidisciplinary debrief. 25 Our intervention although similar did not include interventions towards patient related factors. Their patient interventions included ensuring all patients arrived at 4:30 a.m. regardless of scheduled surgery time, improved patient registration and scheduling, designated patient parking, and greeters who met patients at the hospital entrance and oriented them to the OR check in process.…”

Section: Discussionmentioning

confidence: 99%

“…Their patient interventions included ensuring all patients arrived at 4:30 a.m. regardless of scheduled surgery time, improved patient registration and scheduling, designated patient parking, and greeters who met patients at the hospital entrance and oriented them to the OR check in process. 25 Following their interventions, they improved their proportion of OR on-time starts to 73% from 23.5%. Their most common reasons for delays included surgeon delays (35.9%), equipment issues (21.5%), anesthesia delays (17.2%), and patient related factors (11.4%).…”

Section: Discussionmentioning

confidence: 99%

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Resident-Driven Holistic Lean Daily Management System to Enhance Care Experience at a Safety Net Hospital

Tresh

Cohen

Mmonu

et al. 2020

Urology

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OBJECTIVE To describe the use of Lean in urology at Zuckerberg San Francisco General, a community safetynet and trauma hospital that serves as a major teaching site for the University of California San Francisco. METHODS We examined our process improvement activities from 2016 to 2018. Our Lean Daily Management System (DMS) includes a 15-minute team huddle ("urology Lean work") of service residents, faculty, clinic and operating room nursing staff, and anesthesia liaisons. Our DMS also includes a 5minute preoperative huddle. Besides team-building, urology Lean work surfaces logistics, safety or equipment improvement ideas, and ensures progress and completion of initiated projects. RESULTS Over a 2-year period we developed and completed 67 projects. Projects impacted the outpatient setting (57%), followed by the operating room (22%), the Urology service (12%), and inpatient setting (9%). We completed projects in the following domains: safety (26%), quality (22%), care experience (21%), workforce care and development (13%), equity (11%), and financial stewardship (7%). Urology Lean work reduced new patient clinic access time (119-21 days) and Bacillus Calmette-Gu erin in clinic treatment time (180-105 minutes). The average proportion of urology on-time surgeries was better than the overall surgery on-time surgeries (71% v 61%). CONCLUSION Urology Lean work successfully applied DMS in a service specific yet holistic approach. Urology Lean work improved resident engagement in quality and safety endeavors and served as a DMS model throughout perioperative and clinic areas. UROLOGY 140: 56−63, 2020.

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Section: Discussioncontrasting

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Resident-Driven Holistic Lean Daily Management System to Enhance Care Experience at a Safety Net Hospital

Tresh

Cohen

Mmonu

et al. 2020

Urology

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“…In other examples, LSS implementation has been associated with improved OR turnover times 7 and ontime first starts. [12][13][14] LSS implementation can also result in improvements that extend beyond the OR. For example, with the implementation of a specific clinical pathway for hip fractures, Niemeijer et al 15 revealed the simultaneous reduction of operating time by 57 minutes and-outside of the confines of the OR-a decrease in length of stay by over 4 days.…”

Section: Discussionmentioning

confidence: 99%

Perioperative Anesthesia Lean Implementation Is Associated With Increased Operative Efficiency in Posterior Cervical Surgeries at a HighVolume Spine Center

et al. 2020

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Objective: Lean management strategies aim to increase efficiency by eliminating waste or by improving processes to optimize value. The operating room (OR) is an arena where these strategies can be implemented. We assessed changes in OR efficiency after the application of lean methodology on perioperative anesthesia associated with posterior cervical spine surgeries. Methods: We utilized pre-and post-lean study design to identify inefficiencies during the perioperative anesthesia process and implemented strategies to improve the process. Patient characteristics were recorded to assess for differences between the 2 groups (group 1, prelean; group 2, post-lean). In the pre-lean period, key steps in the perioperative anesthesia process were identified that were amenable to lean implementation. The time required for each identified key step was recorded by an independent study coordinator. The times for each step were then compared between the groups utilizing univariate analyses. Results: After lean implementation, there was a significant decrease in overall perioperative anesthesia process time (88.4 ± 4.7 minutes vs. 76.2 ± 3.2 minutes, p = 0.04). This was driven by significant decreases in the steps: transport and setup (10.4 ± 0.8 minutes vs. 8.0 ± 0.7 minutes, p = 0.03) and positioning (20.8 ± 2.1 minutes vs. 15.7 ± 1.3 minutes, p = 0.046). Of note, the total time spent in the OR was lower for group 2 (270.1 ± 14.6 minutes vs. 252.8 ± 14.1 minutes) but the result was not statistically significant, even when adjusting for number of operated levels. Conclusion: Lean methodology may be successfully applied to posterior cervical spine surgery whereby improvements in the perioperative anesthetic process are associated with significantly increased OR efficiency.

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Prozessoptimierung im operativen Bereich

et al. 2020

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Lean methods to improve operating room elective first case on-time starts in a large, urban, safety net medical center

Cited by 21 publications

References 20 publications

Resident-Driven Holistic Lean Daily Management System to Enhance Care Experience at a Safety Net Hospital

Resident-Driven Holistic Lean Daily Management System to Enhance Care Experience at a Safety Net Hospital

Perioperative Anesthesia Lean Implementation Is Associated With Increased Operative Efficiency in Posterior Cervical Surgeries at a HighVolume Spine Center

Prozessoptimierung im operativen Bereich

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