Reducing door-to-needle times using Toyota's lean manufacturing principles and value stream analysis.
Reducing door-to-needle times using Toyota's lean manufacturing principles and value stream analysis.
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DOI：
10.1161/strokeaha.112.670687
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发表时间：
2012-12
期刊：
影响因子：
8.3
通讯作者：
Lee JM
中科院分区：
文献类型：
--
作者：
Ford AL;Williams JA;Spencer M;McCammon C;Khoury N;Sampson TR;Panagos P;Lee JM
早期tPA治疗急性缺血性卒中提高了疗效，促使国家努力减少从门到针的时间（DNTs）。我们利用精益过程改进方法来制定一个流线型的静脉tPA方案。2011年初，一个多学科团队利用价值流分析（VSA）分析了静脉注射tPA治疗急性缺血性卒中患者所需的步骤。我们直接比较了tpa治疗的“vsa前”和“vsa后”患者的基线特征、方案指标和临床结果。VSA显示了几个tPA方案的效率低下：将患者送到房间，然后去CT，然后再回到房间；工作流的串行处理；还有等待化验结果的时间。2011年3月1日，一项新的方案包含了减少延误的变化：在病房之前将患者直接送往头部CT，利用并行流程工作流程，并实施点护理实验室。在vsa前后，分别有132例和87例患者接受静脉tPA治疗。与vsa前相比，在vsa后，dnt和在到达医院后≤60分钟接受治疗的患者百分比分别得到改善：60分钟对39分钟（p<0.0001）和52%对78% (p<0.0001)，症状性出血率没有变化。精益过程改进方法可以加快时间依赖性中风护理，而不影响安全性。
Earlier tPA treatment for acute ischemic stroke increases efficacy, prompting national efforts to reduce door-to-needle times (DNTs). We utilized lean process improvement methodology to develop a streamlined IV tPA protocol. In early 2011, a multi-disciplinary team analyzed the steps required to treat acute ischemic stroke patients with IV tPA, utilizing value stream analysis (VSA). We directly compared the tPA-treated patients in the “pre-VSA” epoch to the “post-VSA” epoch with regard to baseline characteristics, protocol metrics, and clinical outcomes. The VSA revealed several tPA protocol inefficiencies: routing of patients to room, then to CT, then back to room; serial processing of work flow; and delays in waiting for lab results. On 3/1/2011, a new protocol incorporated changes to minimize delays: routing patients directly to head CT prior to patient room, utilizing parallel process work-flow, and implementing point-of-care labs. In the pre-and post-VSA epochs, 132 and 87 patients were treated with IV tPA, respectively. Compared to pre-VSA, DNTs and percent of patients treated ≤60 minutes from hospital arrival were improved in the post-VSA epoch: 60 min vs. 39 min (p<0.0001) and 52% vs. 78% (p<0.0001), respectively, with no change in symptomatic hemorrhage rate. Lean process improvement methodology can expedite time-dependent stroke care, without compromising safety.