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INTRODUCTION: Lean methodologies have been used in business, particularly automotive manufacturing, since the 1980's. Key concepts include just in time inventory, elimination of waste or muda, and quality improvement by focusing on customers and employees. The technique has also been applied in healthcare, particularly emergency rooms, however, data is limited in OB/GYN settings. This article focuses on a lean project in Knoxville, Tennessee. METHODS: Women's Specialty Care, a group of general OB/GYN academic specialists, needed to increase physician numbers in 2015. Four additional physicians were hired doubling the number of the physicians in less than 6 months. An issue arose with how to accommodate eight physicians with resources designed for four. A lean project began in early 2016. Inventory storage was organized and evaluated for overstocking. A standardized restocking system was implemented for exam rooms. Front office space was cleaned and waste eliminated. A patient flow analysis was performed and the office restructured. As staff became more involved in the process, they developed an improved check in system saving staff about 2 hours per day. RESULTS: After the 10 month project, all physicians could see patients in the existing space with no additional staff. Patient throughput at the main office improved from approximately forty to seventy patients per day. Additionally, staff morale improved. CONCLUSION: In this example, lean techniques were used to improve efficiency in an outpatient OB/GYN setting with excellent results. Lean events should be used and evaluated in other OB/GYN settings to see if the concept is effective in this specialty.

Objective To evaluate fetomaternal bleeding following routine cesarean delivery compared with cesarean delivery involving transplacental transection. Study Design A prospective cohort study evaluating cesarean delivery in which the placenta was transected (cases) versus controls (placenta not transected) from January 2016 to April 2018. A maternal Kleihauer–Betke's (KB) test and newborn hematocrit were performed shortly after delivery. Results The rate of a positive KB test was not significantly different between cases (n = 31) and controls (n = 61) (19 vs. 14%; odds ratio [OR]: 1.44; 95% confidence interval [CI]: 0.46–4.49; p = 0.74). Median neonatal hematocrits were not different. However, the rate of newborn hematocrits <40% at delivery was higher in cases compared with controls (23 vs. 3%; OR: 8.90; 95% CI: 1.72–45.90; p = 0.005). Conclusion A cesarean requiring transplacental transection to accomplish delivery does not significantly increase the rate of fetomaternal bleeding but is associated with a higher likelihood of newborn hematocrit <40% at delivery.