One-Stop Cholecystectomy Clinic: An Application of Lean Thinking - Can it Improve the Outcomes?

Abstract

Lean thinking principles were utilised to set up 'One-stop cholecystectomy clinics' at which patients underwent the surgical and the preoperative assessment during the same visit. The main aims were to reduce the number of patient hospital visits, preoperative admissions and the waiting time to surgery. The results showed a significant reduction in the number of patient visits as well as the waiting time to surgery thus highlighting that patientcare can be improved by good team working and lean management.

Single hospital visit day case laparoscopic hernia repair without prior outpatient consultation is safe and acceptable to patients

“…We highlight patients were not excluded due to co-morbidity, age or obesity and this is the first series containing multiple hernia types. One-stop series of open [10] and TEP inguinal hernia repairs [11,12], laparoscopic cholecystectomies [13] and paediatric surgery [14,15] have previously been reported confirming proof of principle. In contrast to these reports, our patients were seen and examined within the day surgery unit alone and had no contact with any preassessment service.…”

Improving flow in the OR

“…These projects produced an improvement in the OR without targeting clinical practices in the OR itself, including anesthesia. Only a few studies have assessed the impact of an improvement project on non-clinical OR activities such as OR start delay, throughput time in OR, workflow efficiency, or pre-operative processes (Celik, 2003; Cima et al , 2011; Collar et al , 2012; Siddique et al , 2012; van Vliet et al , 2010). Cima et al (2011) constructed a value stream map of entire surgical process from the decision of surgery to discharge.…”

“…Most of the studies so far on Lean projects in surgery settings assess clinical outcomes such as surgical techniques, antibiotic use, nosocomial infections risk, patients outcomes, complications, mortality, or length of surgery (Burkitt et al , 2009; Celik, 2003; Collar et al , 2012; Frankel et al , 2005; Iannettoni et al , 2011; Martinez et al , 2011; McCulloch et al , 2010; Muder et al , 2008; Parker et al , 2007; Siddique et al , 2012; Taner, 2013; van Vliet et al , 2010; Yousri et al , 2011). A recent systematic review on the use of Lean Six Sigma methodologies in surgery shows that a broad range of outcomes are assessed in the included studies (Mason et al , 2015).…”