Lean Six Sigma to Reduce Intensive Care Unit Length of Stay and Costs in Prolonged Mechanical Ventilation

Trzeciak, Stephen; Mercincavage, Michael; Angelini, Cory; Cogliano, William; Damuth, Emily; Roberts, Brian W.; Zanotti, Sergio; Mazzarelli, Anthony

doi:10.1097/jhq.0000000000000075

Cited by 34 publications

(34 citation statements)

References 25 publications

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“…The synergy of both LH and SS methodologies, that is LSS, seems to be one of the most innovative and effective approaches in "Operational Excellence" [25], and are effective quality improvement methods widely adopted by manufacturing industries that are currently also implemented in many health care settings [26]. In the field of health care, LSS has been used to address numerous health care problems [27], some of them include areas as: Trauma center [28], Cardiology [29], Surgery [30], operating room [31], Intensive care unit [32], rehabilitation ward [23], and Otolaryngology care [33].…”

Section: Introductionmentioning

confidence: 99%

Efficiency through a Lean Healthcare Implementation in a Public Hospital

Rosas-Hernandez¹,

Tlapa²,

Báez-López³

et al. 2019

Preprint

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Hospitals face challenges to improve efficiency in order to meet an increasing demand for high quality of care and low costs. Industry-based methods such as lean healthcare (LH) are implemented to improve healthcare systems. This study presents a LH implementation following the DMAIC approach (Define-Measure-Analysis-Improve-Control) in a Mexican public hospital, and contributes to the literature by analyzing the relation of waste reduction and sustainability. We focused on improving the medical supply chain from a temporary warehouse (TW) to the operating room (OR). Therefore, we analyzed the value stream including main surgical procedures and their related medical supplies, and identified different causes of inefficiency, which were evaluated and controlled. As a result, five types of waste were reduced through different tools including: value stream map, Kanban, 5’s, among others. Over-processing requests were reduced 15.3%; similarly, defective identification numbers were reduced up to 46.5%, redundant processing was improved by 94.8%, unnecessary inventories were reduced near to 2.8% of the TW inventory, and transportation waste was reduced up to 16.7%. As a consequence, the lead-time for the main supplies was reduced 33 days. Results indicate that LH and DMAIC are effective to reduce waste and highly conducive to improve healthcare process sustainability.

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Section: Introductionmentioning

confidence: 99%

Efficiency through a Lean Healthcare Implementation in a Public Hospital

Rosas-Hernandez¹,

Tlapa²,

Báez-López³

et al. 2019

Preprint

View full text Add to dashboard Cite

show abstract

“…Process improvement methods have been used previously to streamline patient flow, thus reducing the cycle time of care processes, including decreasing patient length of stay, reducing discharge time, and decreasing the length of patient visits . While prior investigations have often involved quantitative preintervention and postintervention studies, few included detailed analyzes to identify the root cause of the problem or demonstrated a clear method for how solutions were determined .…”

Section: Introductionmentioning

confidence: 99%

Reducing the length of clinic visits: A process analysis case report

Kovach

Akhuli

2019

Health Planning & Management

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Summary Because the University of Houston Student Health Center often had more demand for services than available appointments, the aim of this study was to streamline their clinic visit process. While appointments were scheduled for 20 minutes, the clinic's patient visit cycle time (from check‐in to check‐out) averaged 70 minutes. This report demonstrats how to perform process analysis using failure modes and effects analysis in order to identify the highest priority cause of waste and how to conduct a detailed evaluation of ideas using a prioritization matrix in order to select the best solution to help streamline a process. Analysis of this clinic's visit process identified that patients (mostly international students) asking many questions during their appointment regarding issues not directly related to their care led to long clinic visits. To address this issue, the clinic recruited a team of international students to create a frequently asked questions video with answers, and the final video was then uploaded to the clinic's Facebook page. Comparing before and after the video was posted showed the clinic's average time for a clinic visit was reduced by more than 15%, and it was able to accommodate nearly 100 additional patient visits per month.

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“…[3] Therefore, it is necessary to assign all the resources within the care process according to time and demand [4] and exclude any intervention provides no-value for MVPs to get the optimum value of all care practices, decreasing the mechanical ventilation and intensive care units (ICUs) beds occupation rate and the total cost of ICU stay. [5,6] In an effort to standardize competency of the care for MVPs, new care concepts have been proposed to ICU community to maximize the value of technical and non-technical components of patients' care. [7] Lean is a systematic approach enterprise that aiming firstly to identifying waste and then eliminating these waste (non-value-added activities).…”

Section: Introductionmentioning

confidence: 99%

“…Value stream map (VSM) is a lean strategy that documents the time for each process step and helps critical care nurses determining which steps in the care process add value to MVPs and which steps take up resources and time and incur cost without adding value. [14,16] Despite the lean concept have been handled in several international researches, [4,6,[9][10][11]17] none of them studied the lean in specific care process provided for the critically ill patients. Moreover, to our knowledge, such studies remain limited in Egypt.…”

Section: Introductionmentioning

confidence: 99%

Lean thinking in total nursing care for mechanically ventilated patients: A new concept in ICU

Abdelaliem

Ahmed

2019

JNEP

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Background: Lean approach is one of the coming revolutions for a better, improved, high-value-based care to maximize the benefit from nursing care activities. Additionally, it can shorten the mechanical ventilation duration and the total intensive care unit stay with a time and cost effective process. Lean is an improvement strategy based on the concept of eliminating the waste and creation of value-added care practices to the patients. Applying lean strategy for mechanically ventilated patients requires critical evaluation of all steps of the care to identify which add value and which do not.Methods: A descriptive research design was used in the current study and two tools were used for data collection in this study: “Lean assessment observational checklist of total care for mechanically ventilated patients”, and “Critical care nurses’ self-report about waste during total care of mechanically ventilated patients”.Results: The differences between value added and non-value added care practice items were not statistically significant in ventilator and patient care practices items (p = .232 and .884) respectively, while there was no statistical difference between the value added and non-value added care practice items in tube care. The differences between the time consumed in all care practices items were statistically significant (p < .001). According to the nurses' self-report, direct care for patients was ranked as the first care category that can increase the cost and effort followed by the indirect care category.Conclusions: Not all care items for mechanically ventilated patients have been added value to the patients. Waste outcomes as reported by nurses resulted in increase their efforts, time of care, in addition to increase the cost of care.

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Lean Six Sigma to Reduce Intensive Care Unit Length of Stay and Costs in Prolonged Mechanical Ventilation

Abstract: We found that a LSS-based clinical redesign reduced hospital LOS and the costs of care for patients with PMV.

Cited by 34 publications

References 25 publications

Efficiency through a Lean Healthcare Implementation in a Public Hospital

Efficiency through a Lean Healthcare Implementation in a Public Hospital

Reducing the length of clinic visits: A process analysis case report

Lean thinking in total nursing care for mechanically ventilated patients: A new concept in ICU

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