Reducing door-to-needle times using Toyota's lean manufacturing principles and value stream analysis.
Stroke
; 43(12): 3395-8, 2012 Dec.
Article
em En
| MEDLINE
| ID: mdl-23138440
ABSTRACT
BACKGROUND AND PURPOSE:
Earlier tissue-type plasminogen activator (tPA) treatment for acute ischemic stroke increases efficacy, prompting national efforts to reduce door-to-needle times. We used lean process improvement methodology to develop a streamlined intravenous tPA protocol.METHODS:
In early 2011, a multidisciplinary team analyzed the steps required to treat patients with acute ischemic stroke with intravenous tPA using value stream analysis (VSA). We directly compared the tPA-treated patients in the "pre-VSA" epoch with the "post-VSA" epoch with regard to baseline characteristics, protocol metrics, and clinical outcomes.RESULTS:
The VSA revealed several tPA protocol inefficiencies routing of patients to room, then to CT, then back to the room; serial processing of workflow; and delays in waiting for laboratory results. On March 1, 2011, a new protocol incorporated changes to minimize delays routing patients directly to head CT before the patient room, using parallel process workflow, and implementing point-of-care laboratories. In the pre and post-VSA epochs, 132 and 87 patients were treated with intravenous tPA, respectively. Compared with pre-VSA, door-to-needle times and percent of patients treated ≤60 minutes from hospital arrival were improved in the post-VSA epoch 60 minutes versus 39 minutes (P<0.0001) and 52% versus 78% (P<0.0001), respectively, with no change in symptomatic hemorrhage rate.CONCLUSIONS:
Lean process improvement methodology can expedite time-dependent stroke care without compromising safety.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Isquemia Encefálica
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Modelos Organizacionais
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Acidente Vascular Cerebral
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Serviços Médicos de Emergência
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Fibrinolíticos
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Tempo para o Tratamento
Tipo de estudo:
Evaluation_studies
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Guideline
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Prognostic_studies
Limite:
Aged
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Aged80
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Ano de publicação:
2012
Tipo de documento:
Article