Lean principles optimize on-time vascular surgery operating room starts and decrease resident work hours
Lean principles optimize on-time vascular surgery operating room starts and decrease resident work hours
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DOI：
10.1016/j.jvs.2013.05.007
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发表时间：
2013-11-01
影响因子：
4.3
通讯作者：
Powell, Richard J.
中科院分区：
文献类型：
--
作者：
Warner, Courtney J.;Walsh, Daniel B.;Powell, Richard J.
目标：精益流程改进技术在工业中用于提高效率和质量，同时控制成本。这些技术在医疗保健中应用较少。本研究评估了精益原则对首例手术室按时启动的有效性，并量化了对住院医师工作时间的影响。方法：使用标准流程改进技术（DMAIC 方法：定义、测量、分析、改进、控制）来确定血管手术首例启动延迟的原因。创建了价值流图和流程图。使用帕累托图和控制图分析过程数据。在实施之前，在计算机和实时环境中识别并模拟高收益的变化。主要结果指标是首例按时开始的比例；次要结果包括医院费用、住院医师查房时间和工作时间。将数据与现有基准进行比较。结果：实施前，39% 的首例病例按时开始。流程图确定了术前住院医师迟到是导致首例病例开始延迟的原因。通过使用清单、标准化和消除非增值活动，识别并改变了常驻舍入流程的低效率。实施流程改进后，第一个案例的准时率在 6 周时提高到 71% (P = .002)。持续改善，1 年准时率达 86% (P < .001)。住院医师查房时间减少了 33%（从 70 分钟减少到 47 分钟）。实施后 9 周，这些变更产生了 12,582 美元的潜在机会成本。结论：使用精益原则可以快速识别和实施围手术期流程变更，从而提高效率并显着节省成本。这种改善持续了一年。下游影响包括提高居民效率和减少工作时间。
Objective: Lean process improvement techniques are used in industry to improve efficiency and quality while controlling costs. These techniques are less commonly applied in health care. This study assessed the effectiveness of Lean principles on first case on-time operating room starts and quantified effects on resident work hours.Methods: Standard process improvement techniques (DMAIC methodology: define, measure, analyze, improve, control) were used to identify causes of delayed vascular surgery first case starts. Value stream maps and process flow diagrams were created. Process data were analyzed with Pareto and control charts. High-yield changes were identified and simulated in computer and live settings prior to implementation. The primary outcome measure was the proportion of on-time first case starts; secondary outcomes included hospital costs, resident rounding time, and work hours. Data were compared with existing benchmarks.Results: Prior to implementation, 39% of first cases started on time. Process mapping identified late resident arrival in preoperative holding as a cause of delayed first case starts. Resident rounding process inefficiencies were identified and changed through the use of checklists, standardization, and elimination of nonvalue-added activity. Following implementation of process improvements, first case on-time starts improved to 71% at 6 weeks (P = .002). Improvement was sustained with an 86% on-time rate at 1 year (P < .001). Resident rounding time was reduced by 33% (from 70 to 47 minutes). At 9 weeks following implementation, these changes generated an opportunity cost potential of $12,582.Conclusions: Use of Lean principles allowed rapid identification and implementation of perioperative process changes that improved efficiency and resulted in significant cost savings. This improvement was sustained at 1 year. Downstream effects included improved resident efficiency with decreased work hours.