Reduced isolation room turnover time using Lean methodology

Abstract

Objective:To prevent environmental transmission of pathogens, hospital rooms housing patients on transmission-based precautions are cleaned extensively and disinfected with ultraviolet (UV) light. To do so consistently requires time and coordination, and these procedures must avoid patient flow delays and associated safety risks. We sought to improve room turnover efficiency to allow for UV disinfection.Design:A 60-day quality improvement and implementation project.Setting:A quaternary academic pediatric referral facility.Interventions:A multidisciplinary healthcare team participated in a 60-day before-and-after trial that followed the Toyota Production System Lean methodology. We used value-stream mapping and manual time studies to identify areas for improvement. Areas addressed included room breakdown, room cleaning, and wait time between cleaning and disinfection. Room turnover was measured as the time in minutes from a discharged patient exiting an isolation room to UV disinfection completion. Impact was measured using postintervention manual time studies.Results:Median room turnover decreased from 130 minutes (range, 93–294 minutes) to 65 minutes (range, 48–95 minutes; P < .0001). Other outcomes included decreased median time between room breakdown to cleaning start time (from 10 to 3 minutes; P = .004), room cleaning complete to UV disinfection start (from 36 to 8 minutes; P < .0001), and the duration of room cleaning and curtain changing (from 57 to 37 minutes; P < .0001).Conclusion:We decreased room turnover time by half in 60 days by decreasing times between and during routine tasks. Utilizing Lean methodology and manual time study can help teams understand and improve hospital processes and systems.

Assessing the Impact of Lean Healthcare on Inpatient Care: A Systematic Review

“…An inefficient preoperative department can delay the start of surgery and impact the patient flow throughout the day [ 112 ], which can affect other outcomes, such as TOT and TAT, which are important performance parameters for the perioperative process. We found that LH led to reductions of TOT in six studies, the largest being a 50% reduction [ 104 ]. In contrast, two papers reported no significant changes in TOT, but other benefits, such as reductions from patient in room to procedure starting or OTS [ 26 , 27 ].…”

“…This importance has been pointed out by other studies [134,[161][162][163][164]. Other common tools include standard work, i.e., a concept whereby each work activity is precisely described with a specific cycle time, task sequence, and other steps involved within the process [95], and is considered a prerequisite for flow [10]; the 5'S program, which is used to eliminate clutter [165] and enhance the standardization of stock, as well as to systematically organize the unit and streamline the documentation processes [97]; cause and effect analyses, which are used to map the possible causes of a problem into categories [90,166]; and Kaizen, which is a philosophy of continuous incremental improvement over time and space [29,99,104]. These findings are similar with those reported in previous studies [44,62,161], and sustain the assertion that most LH interventions focus more on tools related to assessment and improvement and less on processes-monitoring tools.…”

Sustained Reduction in Intravenous Pump Turnaround Time Using Lean Methodology

“…Our short- and long-term success was largely due to our team’s commitment to Lean principles and methods. Historically, Lean’s impact in healthcare has been in short-term gains, 7–10 whereas long-term improvement and sustainability have been less clear. 11,12 This observation may be because, in most healthcare systems, an individual “siloed” focus is the standard and conflicts with Lean’s goal to involve all operators in intervention design and execution, independent of hierarchy.…”

Don’t just do it—Conducting and publishing improvement science in infection prevention and antibiotic stewardship

“…32,33 Application of improvement science principles has improved the consistency of cleaning of hospital-room surfaces and the efficiency of ultraviolet light disinfection. 32,[34][35][36]…”