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American Heart Association

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Hospital uses auto-industry techniques to speed stroke care

A hospital stroke team used automobile industry “lean” manufacturing principles to accelerate treatment times, according to new research1 in the American Heart Association’s journal Stroke.

In a prospective observational study, the average time between patients arriving at a hospital (Barnes-Jewish Hospital, St. Louis Missouri, USA) and receiving tissue plasminogen activator (tPA) decreased 21 minutes using process improvement techniques adapted from car manufacturing. Data from more than 200 patients was included in the study analysis, ranging over three years.

The shorter the time between patients arriving at the hospital and receiving tPA, the greater the chance to reduce brain injury after stroke, researchers said.

Using lean techniques, the hospital’s stroke team identified unnecessary or inefficient steps such as inefficient patient transportation, tasks performed one at a time rather than simultaneously, and time-consuming traditional lab-based tests. Protocols were formulated to eliminate wasteful steps, keeping only crucial steps that added “value” to patient care, in keeping with car manufacturers’ lean methods which eliminate inefficiencies in automobile production.

The team streamlined the process by having emergency medical service (EMS) route patients directly to the computed tomography (CT) scanner for immediate brain imaging, enlisted the help of more team members each with fewer tasks to complete, and instituted bedside tests which provide laboratory results within minutes. These modifications ensured that rapid diagnosis and treatment would be available for patients as soon as they arrived at the Emergency Department.

As a result, 78% of stroke patients received tPA within one hour of arrival, the authors say. The “Get with the Guidelines” national database indicates that currently only about 30% of patients in the USA are treated within one hour. The overall treatment time was reduced from 60 minutes to 39 minutes, sustained for a year after implementation.

The protocol changes did not alter patient safety or clinical outcomes, researchers said. “There is growing awareness that fast and efficient treatment is important for improving the effectiveness of tPA,” said Dr Jin-Moo Lee, lead author of the study (Washington University School of Medicine, St. Louis, USA).

“National guidelines suggest that door-to-needles times should be under 60 minutes, yet these guidelines do not state how this can be achieved. Lean process improvements methodology can be effectively applied towards achieving this and other process improvement goals,” he added.

A larger study is needed to validate results, researchers said.

References

1. Ford AL, Williams JA, Spencer M, et al. Reducing door-to-needle times using Toyota’s lean manufacturing principles and value stream analysis. Stroke 2012;43. http://dx.doi.org/10.1161/STROKEAHA.112.670687

Published on: October 19, 2012

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