Lean Methodology in Health Care

Kimsey, Diane B.

doi:10.1016/j.aorn.2010.01.015

Cited by 89 publications

(61 citation statements)

References 1 publication

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“…An ease impact chart allowed staff to identify the quick wins or opportunities that would make an impact without significant investment in resources and time. Similar to reports in the literature, 11 the use of this lean tool further engaged participants in the change.…”

Section: Discussionsupporting

confidence: 65%

Reducing Unplanned Extubations in the NICU Using Lean Methodology

2016

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BACKGROUND: Unplanned extubations can lead to iatrogenic injury and have the potential to contribute to serious safety events. We adopted lean methodology to reduce the unplanned extubation rate in a Level 3b NICU. We hypothesized that the use of a rapid-cycle PDSA (plan, do, study, act) initiative would reduce the unplanned extubation rate. METHODS: Baseline unplanned extubation data were collected from November 1, 2012 to June 6, 2014. A voice of the customer survey ascertained perceptions regarding unplanned extubation causes and impact on care. The confidential survey contained 2 open-ended and 4 closed-ended questions and was distributed to a random sample of nurses and respiratory therapists. A fishbone diagram helped to identify opportunities. Six improvements were identified and rolled out in 2 phases using didactic and kinesthetic techniques. Phase 1 standardized the process for turning intubated infants, assessing endotracheal tube (ETT) placement with growth, and communicating tube position with caregivers. Phase 2 addressed respiratory plans of care, correcting ETT migration, establishing ETT re-securement methods, and standardizing position during radiography. The Fisher exact test was used to determine differences in the number of unplanned extubations per 100 intubated days. Descriptive statistics were used to report survey results. Statistical significance was established at P < .05. RESULTS: A 68% (17 of 25) survey response rate was realized. Baseline data revealed 3.8 unplanned extubations/100 intubated days, and 2.7 unplanned extubations/100 intubated days occurred in the post-improvement phase (P ‫؍‬ .01). We noted a statistically significant decrease in the number of intubated days between the pre-and post-improvement groups (P < .001). CONCLUSIONS: Staff underestimated the prevalence of unplanned extubations but recognized the need for improvement. Rapid cycle PDSA significantly reduced the unplanned extubation rate. The decrease in intubated days may have been a by-product of the post-improvement phase improvements, which encouraged practice changes.

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Section: Discussionsupporting

confidence: 65%

Reducing Unplanned Extubations in the NICU Using Lean Methodology

2016

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“…The principles of lean management hold each member of the team accountable for creating and using tools, in this case the 3 interventions, to reduce variability in the work process. 14 The integration of staff at all levels in the implementation process through education and feedback facilitated buy-in and fidelity to the 3 interventions. Specifically, the real-time assessment and feedback of patients who were extubated in a timely manner allowed rapid assessment of failure modes and modifications to facilitate protocol fidelity.…”

mentioning

confidence: 99%

“…13 A key component of lean management is holding every individual responsible and accountable to use tools that will reduce variability in the work process. 14 Lean management has been used in many areas of medicine, including critical care. 12,13,15 In this study, we applied the principles of lean management to a cardiac surgery unit within a large academic medical center in order to decrease both the incidence of prolonged mechanical ventilation and the median time to extubation following CABG.…”

mentioning

confidence: 99%

Quality Improvement Intervention to Decrease Prolonged Mechanical Ventilation After Coronary Artery Bypass Surgery

Hefner¹,

Tripathi²,

Abel³

et al. 2016

American Journal of Critical Care

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BackgroundIn 2010, the incidence of prolonged mechanical ventilation (> 24 hours) after isolated coronary artery bypass graft (CABG) surgery was 26.9% at the study site, The Ohio State University Wexner Medical Center, compared with the national like-hospital rate of 10.9%. Objectives To use the principles of lean management to reduce the incidence of prolonged mechanical ventilation and to assess the sustainability of that reduction over time. Methods A multidisciplinary prolonged ventilation task force conducted a gap analysis leading to 3 interventions: (1) a standardized extubation protocol, (2) dry erase boards in patients' rooms to facilitate team communication, and (3) edits of the postoperative order set within the electronic health record. Outcomes of mechanical ventilation in CABG patients before and after the interventions are compared. Results All target outcomes changed significantly after the interventions, including a reduction in the median hours of initial mechanical ventilation (from 11.4 hours to 6.9 hours, P < .001). The percentage of patients reintubated did not increase (a decrease from 11.8% to 3.5% was not significant, P = .08). The rate of prolonged ventilation decreased from 29.4% to 8.6% (P = .004), and this reduction was sustained for 4 years after the interventions. Conclusions Success factors included the multidisciplinary task force and continual protocol reeducation among front-line staff.

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“…Local institutions may address these deficiencies by using established quality improvement methods, such as the Model for Improvement, 39 or waste elimination techniques, such as Lean. 40 These approaches may require innovative tools, 41 as well as multidisciplinary education focused on value in neonatal care. 42 …”

Section: Discussionmentioning

confidence: 99%

Choosing Wisely in Newborn Medicine: Five Opportunities to Increase Value

et al. 2015

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BACKGROUND: The use of unnecessary tests and treatments contributes to health care waste. The “Choosing Wisely” campaign charges medical societies with identifying such items. This report describes the identification of 5 tests and treatments in newborn medicine. METHODS: A national survey identified candidate tests and treatments. An expert panel of 51 individuals representing 28 perinatal care organizations narrowed the list over 3 rounds of a modified Delphi process. In the final round, the panel was provided with Grading of Recommendation, Assessment, Development and Evaluation (GRADE) literature summaries of the top 12 tests and treatments. RESULTS: A total of 1648 candidate tests and 1222 treatments were suggested by 1047 survey respondents. After 3 Delphi rounds, the expert panel achieved consensus on the following top 5 items: (1) avoid routine use of antireflux medications for treatment of symptomatic gastroesophageal reflux disease or for treatment of apnea and desaturation in preterm infants, (2) avoid routine continuation of antibiotic therapy beyond 48 hours for initially asymptomatic infants without evidence of bacterial infection, (3) avoid routine use of pneumograms for predischarge assessment of ongoing and/or prolonged apnea of prematurity, (4) avoid routine daily chest radiographs without an indication for intubated infants, and (5) avoid routine screening term-equivalent or discharge brain MRIs in preterm infants. CONCLUSIONS: The Choosing Wisely Top Five for newborn medicine highlights tests and treatments that cannot be adequately justified on the basis of efficacy, safety, or cost. This list serves as a starting point for quality improvement efforts to optimize both clinical outcomes and resource utilization in newborn care.

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Lean Methodology in Health Care

Cited by 89 publications

References 1 publication

Reducing Unplanned Extubations in the NICU Using Lean Methodology

Reducing Unplanned Extubations in the NICU Using Lean Methodology

Quality Improvement Intervention to Decrease Prolonged Mechanical Ventilation After Coronary Artery Bypass Surgery

Choosing Wisely in Newborn Medicine: Five Opportunities to Increase Value

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