Lean processes for optimizing OR capacity utilization: prospective analysis before and after implementation of value stream mapping (VSM).

ABSTRACT

BACKGROUND: The decision to optimize the processes in the operating tract was based on two factors competition among clinics and a desire to optimize the use of available resources. The aim of the project was to improve operating room (OR) capacity utilization by reduction of change and throughput time per patient. SETTING: The study was conducted at Centre Hospitalier Emil Mayrisch Clinic for specialized care (n = 618 beds) Luxembourg (South). METHOD: A prospective analysis was performed before and after the implementation of optimized processes. Value stream analysis and design (value stream mapping, VSM) were used as tools. VSM depicts patient throughput and the corresponding information flows. Furthermore it is used to identify process waste (e.g. time, human resources, materials, etc.). For this purpose, change times per patient (extubation of patient 1 until intubation of patient 2) and throughput times (inward transfer until outward transfer) were measured. VSM, change and throughput times for 48 patient flows (VSM A(1), actual state = initial situation) served as the starting point. Interdisciplinary development of an optimized VSM (VSM-O) was evaluated. Prospective analysis of 42 patients (VSM-A(2)) without and 75 patients (VSM-O) with an optimized process in place were conducted. RESULTS: The prospective analysis resulted in a mean change time of (mean ± SEM) VSM-A(2) 1,507 ± 100 s versus VSM-O 933 ± 66 s (p < 0.001). The mean throughput time VSM-A(2) (mean ± SEM) was 151 min (±8) versus VSM-O 120 min (±10) (p < 0.05). This corresponds to a 23% decrease in waiting time per patient in total. CONCLUSION: Efficient OR capacity utilization and the optimized use of human resources allowed an additional 1820 interventions to be carried out per year without any increase in human resources. In addition, perioperative patient monitoring was increased up to 100%.