PurposeThis case study aims to demonstrate the strengths of the Lean Six Sigma (LSS) methodology to improve the acute ischemic stroke (AIS) treatment rates and reduce process lead time at Baruch Padeh Medical Center (BPMC), a rural hospital in the Galilee region of Northern Israel. The LSS project redefined the BPMC stroke care pathway and increased its efficacy.Design/methodology/approachThe LSS methodology was implemented in September 2017 by integrating lean principles and the Six Sigma DMAIC (Define–Measure–Analyze–Improve–Control). Existing procedures, field observation, ad hoc measurement and in-depth interviews were utilized, and the GEMBA method was implemented to identify root cause and improve actions optimizing the stroke pathway.FindingsThe presented case shows the usefulness of the LSS methodology in improving quality performance in a rural hospital. The intervention allowed the BPMC to improve the intravenous tissue plasminogen activator (IV-tPA) administration rate (+15.2%), reducing the process lead time. The lead time of door-to-computer tomography decreased from 52 to 26 min, and the door-to-needle time decreased from 94 to 75 min.Originality/valueThe present case study shows the implementation of the LSS methodology aimed to improve the IV-tPA administration rate and reduce the stroke pathway lead time in a rural hospital. The case demonstrates the potential for the LSS methodology to support the AIS pathway optimization and represents a guide for healthcare organizations located in rural areas.

Every year Christian pilgrims from around the world visit the holy sites located around the Sea of Galilee. Some become ill during their stay with infectious diseases that were acquired in their country of origin, and are hospitalized at Poriya Medical Center. They pose a diagnostic challenge due to language barriers, the rarity of these infections in Israel, and the fact that diagnostic tests are not readily available. All patient records from 2015 of Holy Land tourists hospitalized at Poriya Medical Center were screened for the diagnosis of imported zoonotic diseases that are not commonly diagnosed in Israel. Three patients who were on a Holy Land tour were hospitalized during 2015 with laboratory-confirmed diagnostically challenging zoonotic infectious diseases: a 91-year-old priest from Ethiopia diagnosed with relapsing fever due to , an 85-year-old retired mountaineer from New Hampshire diagnosed with human granulocytic anaplasmosis, and a 57-year-old farmer from central Brazil diagnosed with leptospirosis. These case reports emphasize the importance of considering imported zoonotic infectious diseases and obtaining appropriate diagnostic tests when treating Holy Land travelers to Israel.

For the acutely dyspneic patient, discerning bedside between acute decompensated heart failure (ADHF) and COVID-19 is crucial. A lung ultrasound (LUS) is sensitive for detecting these conditions, but not in distinguishing between them; both have bilateral B-lines. The Blue protocol uses pleural sliding to differentiate decreased pneumonia; however, this is not the case in ADHF. Nonetheless, this pleural sliding has never been quantified. Speckled tracking is a technology utilized in the echocardiography field that quantifies the motion of tissues by examining the movement of ultrasound speckles. We conducted a retrospective study of LUS performed in emergency room patients during the COVID-19 pandemic. Speckled tracking of the pleura by applying software to the B-mode of pleura was compared between COVID-19 patients, ADHF patients, and patients with no respiratory complaints. A significant difference was found between the patient groups on speckled tracking both in respect of displacement and velocity. ADHF had the highest displacement, followed by COVID-19, and then non-respiratory patients: 1.63 ± 1.89, 0.59 ± 0.71, and 0.24 ± 0.45, respectively (p < 0.01). A similar trend was seen in velocity with ADHF having the highest velocity 0.34 ± 0.37, followed by COVID-19 0.14 ± 0.71, and non-respiratory patients 0.02 ± 0.09 (p <0.01). Speckled tracking of the pleura is a potential tool for discerning between different causes of dyspnea.