Lean techniques to improve flow of critically ill patients in a health region with its epicenter in the intensive care unit of a reference hospital

Sirvent, Josep Ma; Gil, M.; Álvarez, Tania Roig; Martín, S.; Vila, Noelia Araújo; March, Evarist; Loma-Osorio, Pablo; Metje, T.

doi:10.1016/j.medine.2015.08.007

Cited by 13 publications

(25 citation statements)

References 14 publications

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“…18,19 Increasing the efficiency of hospital-based clinical care by applying LH was identified as a potent strategy for lowering costs and improving outcomes. 20 Some areas where LH has been implemented include: intensive care units (ICUs), 21 cardiology, 22 surgery, 23 gynecologic oncology, 24 colonoscopy, 25 pathology, 26 radiology, 27 mental health units, 28 eye hospitals, 29 otolaryngology, 30 ultrasound-otolaryngology, 31 organ transplant centers, 32 and clinical laboratories, 33 to name but a few. In the United States, a national survey found that around 70% of hospitals use LH or related approaches.…”

Section: Introductionmentioning

confidence: 99%

Effects of Lean Healthcare on Patient Flow: A Systematic Review

et al. 2020

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Objectives: To assess the effects of lean healthcare (LH) on patient flow in ambulatory care and determine whether waiting time and length of stay (LOS) decrease after LH interventions. Methods: A systematic review was performed with close adherence to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We searched for studies of healthcare organizations applying LH interventions within ambulatory care published between 2002 and 2018. Six databases and grey literature sources were used. Two reviewers independently screened and assessed each study. When consensus was difficult to reach, a third reviewer intervened. Finally, a summary of findings was generated. Results: Out of 5627 studies, 40 were included. Regarding LOS for all patients, 19 out of 22 studies reported a decrease. LOS for discharged patients decreased in 11 out of 13 studies, whereas LOS for admitted patients was reduced in 6 out of 7 studies. Waiting time for patients before seeing a healthcare professional decreased in 24 out of 26 studies. Waiting time to treatment and waiting time for appointments were minimized in 4 and 2 studies, respectively. Patients who left without being seen by a doctor decreased in 9 out of 12 studies. Finally, patient and staff satisfaction were measured in 8 and 2 studies, respectively, with each reporting improvements. Conclusions: According to our findings, LH helped to reduce waiting time and LOS in ambulatory care, mainly owing to its focus on identifying and minimizing non-value added (NVA) activities. Nevertheless, evidence of the impact of LH on patient/ staff satisfaction and the translation of the obtained benefits into savings is scarce among studies.

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Section: Introductionmentioning

confidence: 99%

Effects of Lean Healthcare on Patient Flow: A Systematic Review

et al. 2020

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“…The full list of studies included [19,38,[46][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64][65] and their main characteristics are shown in Table 2 Additional le 2.…”

Section: Resultsmentioning

confidence: 99%

“…measured the HAI as primary outcome measure and 8 studies[50-53, 57-59, 64] the healthcare worker compliance. Five studies[38,47,52,60,62] included relevant data on unexpected mortality and 2 studies[48,59] on healthcare workers satisfaction".…”

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confidence: 99%

Can lean reduce infections? A systematic review and meta-analysis of prospective studies

Patrone

Cristina²,

Spagnolo

et al. 2020

Preprint

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Background: Lean is largely applied to the health sector and on the healthcare-associated infections (HAI). The latter are a plague for our society. However, a few results on the improvement of the outcome have been reported in literature. The purpose of this study is to analyze if the lean application can reduce the healthcare-associated infections rate.Methods: A comprehensive search was performed on PubMed/Medline, Scopus, CINAHL, Cochrane, Embase, and Google Scholar databases using various combinations of the following keywords: "lean" and "infection" from August to December 2019. Inclusion criteria were: 1) research articles with quantitative data and relevant information on lean methodology and its impact on healthcare infections; 2) prospective studies. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines has been used.Results: 22 studies were included in the present meta-analysis. Lean application demonstrated a significant protective role on healthcare-associated infections rate (RR 0.50 [0.38-0.66]) with significant impact on central line-associated bloodstream infections (CLABSIs) (RR 0.47 [0.28-0.82]). There was a significant correlation between lean application and healthcare worker satisfaction and compliance, but no significant decrease of mortality has been reported.Conclusions: Lean has a positive impact on the decreasing of HAIs and on the improvement of compliance and satisfaction of the staff.

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“…[2,3] Direct and indirect care together with other practices such as unit related practices and personal practices are occupying the time the critical care nurses spend with MVPs. [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.…”

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 techniques to improve flow of critically ill patients in a health region with its epicenter in the intensive care unit of a reference hospital

Cited by 13 publications

References 14 publications

Effects of Lean Healthcare on Patient Flow: A Systematic Review

Effects of Lean Healthcare on Patient Flow: A Systematic Review

Can lean reduce infections? A systematic review and meta-analysis of prospective studies

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

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