Applying the Lean principles of the Toyota Production System to reduce wait times in the emergency department

Ng, David Wei Liang; Vail, G H; Thomas, Shannon D.; Schmidt, Nicki

doi:10.1017/s1481803500012021

Cited by 148 publications

(156 citation statements)

References 3 publications

(4 reference statements)

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“…To minimize process-related delays, such as those observed in this last stage, researchers (26)(27) favor the applicability of the concepts of automation in a hospital environment, not only for activities such as laboratory flows and resource management, for instance, but also to guarantee that the flow of attendance for patients and communication among the professionals are safer, more economic, and efficient. In this context, ready-foruse diets (closed system) could be configured as alternatives.…”

Section: Discussionmentioning

confidence: 99%

Nasoenteral tube: factors associated with delay between indication and use in emergency services

et al. 2017

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Objective: to know the time between indication and use of a nasoenteral tube (NET) and factors associated with delays. Method: A prospective cohort study that followed adults in a Brazilian emergency department, since the indication of the use of a NET, evaluating clinical variables and the work process. The Generalized Estimated Equations model was adopted to identify factors associated with the delays in each stage of the process. Results: the time between indication and use of NET was 573 (IQR: 360-1,093) minutes, in 150 insertions of NET. Insertions in patients who previously did not use it; delays in the medical, nutrition, and nursing care routine; use of mechanical ventilation; noradrenaline; and fasting were factors for longer time before the use of the tube. Conclusion: the time between indication and use of NET was high, exceeding 10 hours in half of the cases. Factors related to the clinical condition of the patient and to the care management would contribute to delays. Descriptors: Nursing Care; Emergency Medical Services; Gastrointestinal Intubation; Treatment Time; Patient Safety. RESUMO Objetivo: conhecer o tempo entre indicação e uso da sonda nasoenteral (SNE) e fatores associados a atrasos. Método: coorte prospectiva que acompanhou adultos de uma Emergência brasileira, desde a indicação ao uso da SNE, avaliando-se variáveis clínicas e do processo de trabalho. Adotou-se o modelo de Equações de Estimações Generalizadas para identifi car fatores associados a atrasos em cada etapa do processo. Resultados: o tempo entre indicação e uso da SNE foi 573 (IQR: 360-1093) minutos, em 150 inserções de SNE. Inserções em pacientes que anteriormente não a utilizavam, retardos na rotina assistencial médica, da nutrição e enfermagem, uso de ventilação mecânica, noradrenalina e jejum foram fatores para maior tempo até o uso da sonda. Conclusão: o tempo entre indicação e uso de SNE foi elevado, excedendo 10 horas em metade dos casos. Fatores relacionados às condições clínicas do paciente e à gestão da assistência contribuiriam para atrasos. Descritores: Cuidados de Enfermagem; Serviços Médicos de Emergência; Intubação Gastrointestinal; Tempo para o Tratamento; Segurança do Paciente. RESUMENObjetivo: conocer el tiempo entre indicación y uso de sonda nasogástrica (SNG) y factores asociados a demoras. Método: cohorte prospectivo que observó adultos en Servicio de Urgencia brasileño, desde indicación hasta uso de la SNG, evaluándose variables clínicas del proceso de trabajo. Se adoptó modelo de Ecuaciones de Estimación Generalizada para identifi car factores asociados a demoras en cada etapa del proceso. Resultados: el tiempo entre indicación y uso de SNG fue 573 (IQR=360α1093) minutos, en 150 inserciones de SNG. Las inserciones en pacientes que no la utilizaban previamente, demoras en rutina de atención médica, Rev Bras Enferm [Internet]. 2017 mar-apr;70(2):326-34. 327Nasoenteral tube: factors associated with delay between indication and use in emergency services

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Section: Discussionmentioning

confidence: 99%

Nasoenteral tube: factors associated with delay between indication and use in emergency services

et al. 2017

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“…Recently, American, Australian, and Canadian EDs have effectively applied Lean principles. [8][9][10][11][12] Their successes demonstrate the applicability of Lean to the health care sector. 13 However, little research has been conducted in this area, particularly regarding ACS care specifically.…”

Section: Ré Sumémentioning

confidence: 99%

Application of Lean principles to improve early cardiac care in the emergency department

Piggott

Weldon

Strome

et al. 2011

CJEM

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Objective: To achieve our goal of excellent emergency cardiac care, our institution embarked on a Lean process improvement initiative. We sought to examine and quantify the outcome of this project on the care of suspected acute coronary syndrome (ACS) patients in our emergency department (ED). Methods: Front-line ED staff participated in several rapid improvement events, using Lean principles and techniques such as waste elimination, supply chain streamlining, and standard work to increase the value of the early care provided to patients with suspected ACS. A chart review was also conducted. To evaluate our success, proportions of care milestones (first electrocardiogram [ECG], ECG interpretation, physician assessment, and acetylsalicylic acid [ASA] administration) meeting target times were chosen as outcome metrics in this before-and-after study. Results: The proportion of cases with 12-lead ECGs completed within 10 minutes of patient triage increased by 37.4% (p , 0.0001). The proportion of cases with physician assessment initiated within 60 minutes increased by 12.1% (p 5 0.0251). Times to ECG, physician assessment, and ASA administration also continued to improve significantly over time (p values , 0.0001). Post-Lean, the median time from ECG performance to physician interpretation was 3 minutes. All of these improvements were achieved using existing staff and resources. Conclusions: The application of Lean principles can significantly improve attainment of early diagnostic and therapeutic milestones of emergency cardiac care in the ED. RÉ SUMÉObjectif : Pour atteindre notre objectif d'excellence en soins d'urgence cardiaque, notre é tablissement a mis sur pied une initiative d'amé lioration du processus Lean. Nous nous sommes attaché s à é tudier et à quantifier les ré sultats de ce projet en lien avec les soins aux patients soupç onné s d'ê tre atteints de syndrome coronarien aigu (SCA) dans notre service des urgences (SU). Mé thodes : Le personnel de premiè re ligne du SU a participé à plusieurs é vé nements d'amé lioration rapide constitué s des principes et techniques Lean : é limination du gaspillage (temps, ressources), allé gement de la chaîne logistique, travail standard, et ce, pour augmenter la qualité des soins pré coces fournis aux patients chez qui on soupç onne un SCA. Une revue des dossiers a é galement é té mené e. Pour é valuer notre succè s, nous avons choisi, comme mesure des ré sultats dans cette é tude « avant-aprè s », la proportion des é tapes de soins (premier é lectrocardiogramme [ECG], interpré tation de l'ECG, é valuation par le mé decin et administration d'acide acé tylsalicylique [AAS]) respectant le temps visé .

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“…Figure 1 gives a complete picture of motor vehicle exports over the past decade; During the stagnation of the Japanese economy for over a decade, Toyota Motor Company retained about 50% of its global production in Japan and ranked as the world's most successful automaker, totally outperforming its competitors in terms of quality products and reliable services by applying lean production [9,10]. Lean manufacturing has been used in a variety of industries as a creative method that eliminates waste while increasing productivity [11,12]. Companies can predict short supply lines based on a lean method that delivers small batches of components to the assembly line steadily without interruption [13].…”

Section: Introductionmentioning

confidence: 99%

An Innovative Approach to Enhancing the Sustainable Development of Japanese Automobile Suppliers

Wang

Huang

et al. 2016

Sustainability

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Abstract:The Japanese automobile industry has been hit sharply by the economic downturn of recent decades. The rise in costs and decline in sales have led to serious problems in the auto industry. In order to address these issues, most companies engage in downsizing and redesigning production operations. It is crucial to investigate the time wasted by replacing assembly boards occurring in manufacturing lines. Therefore, the aim of this study was to provide an integrated approach, Teoriya Resheniya Izobreatatelskih Zadatch (TRIZ), to providing efficient solutions for the automobile industry. The first step of this methodology is to detail the technical problems using the Function and Attribute Analysis (FAA) model. Secondly, a contradiction matrix and the inventive principle were applied to find the solutions. In this study, an auto part supplier named Sumi-Hanel located in Hanoi, Vietnam, was taken as a case study; the empirical results showed that waste time had been reduced to 67%, nearly 8400 square meters was saved, and a 20% cost reduction was achieved by reusing old frames. The research proves that the combination of TRIZ and lean manufacturing successfully increases production performance and reduces waste due to technological advancements.

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Applying the Lean principles of the Toyota Production System to reduce wait times in the emergency department

Cited by 148 publications

References 3 publications

Nasoenteral tube: factors associated with delay between indication and use in emergency services

Nasoenteral tube: factors associated with delay between indication and use in emergency services

Application of Lean principles to improve early cardiac care in the emergency department

An Innovative Approach to Enhancing the Sustainable Development of Japanese Automobile Suppliers

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