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Streamlining processes helps hospitalís stroke patients

Thursday October 18, 2012
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A hospital stroke team used auto industry "lean" manufacturing principles to accelerate treatment times, according to a report.

In a prospective observational study, the average time between patientsí arrival at Barnes-Jewish Hospital in St. Louis and treatment with tissue plasminogen activator decreased 21 minutes using process improvement techniques adapted from auto manufacturing. Data from more than 200 patients over a three-year period was included in the study analysis.

Using the process improvement techniques, the hospitalís stroke team identified unnecessary or inefficient steps involving patient transportation, bedside tasks and lab-based tests. Protocols were formulated to eliminate wasteful steps, keeping only crucial steps that added "value" to patient care, in keeping with auto-manufacturersí lean methods that eliminate inefficiencies in automobile production.

The team streamlined the process by having EMS route patients directly to the CT scanner for immediate brain imaging, enlisted the help of more team members each with fewer tasks to complete, and instituted bedside tests that 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 ED.

As a result, 78% of stroke patients received tPA within one hour of arrival. The American Heart Associationís "Get with the Guidelines" national database indicates that only about 30% of patients in the United States are treated within one hour. The average treatment time was reduced from 60 minutes to 39 minutes and was sustained for a year after implementation.

The protocol changes did not alter patient safety or clinical outcomes, the researchers said.

"There is growing awareness that fast and efficient treatment is important for improving the effectiveness of tPA," Jin-Moo Lee, MD, PhD, the studyís lead author and director of the Cerebrovascular Disease Section in the Department of Neurology at Washington University School of Medicine in St. Louis, said in a news release. "National guidelines suggest that door-to-needle 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 toward achieving this and other process improvement goals." A larger study is needed to validate the results, researchers said.

The study is scheduled for publication in the journal Stroke. An abstract of a previous presentation of the study is available at http://stroke.ahajournals.org/cgi/content/meeting_abstract/43/2_MeetingAbstracts/A175.


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