(1313 Wang H, Bilbao MS, Miller SL, O'Donnell CT, Boyd JH. Endoscopic radial artery harvesting during anesthesia line placement reduces the time and cost of multivessel coronary artery bypass grafting. Innovations (Phila). 2020;15(1):43-50. https://doi.org/10.1177/1556984519882014
https://doi.org/10.1177/1556984519882014...
)
|
Assess the effect of a pre-sternotomy radial artery (RA) harvesting strategy on surgery time and costs. |
Comparative study, carried out at the Stanford University School of Medicine. Thus, 41 patients underwent elective myocardial revascularization, for the first time, with extracorporeal circulation using two techniques (phases I and II) with different resources. Lean management concepts were used, with reference to improving workflows and operating room efficiency, resulting in shorter and less expensive surgeries. |
- A reduction in the total surgery time (from 287 minutes and 5 seconds to 255 minutes and 5 seconds) and a reduction in the total time used in the operating room (from 380 minutes and 8 seconds to 145 minutes and 3 seconds) were identified;
- After statistical analysis, an average saving in surgical time of 33 minutes and 3 seconds and an average total saving in surgery time of 35 minutes in phase II were revealed.
- The strategy used in phase II requires only one endoscopic conduit collection kit to be used per operation, saving 8.0% of surgery-related costs per patient. |
The strategy improves intraoperative workflow, reduces surgery time and cost, and advances the delivery of high-quality care to patients. |
(1717 Barros LB, Bassi LC, Caldas LP, Sarantopoulos A, Zeferino EBB, Minatogawa V, Gasparino RC. Lean healthcare tools for processes evaluation: an integrative review. Int J Environ Res Public. 2021;18(14):7389. https://doi.org/10.3390/ijerph18147389
https://doi.org/10.3390/ijerph18147389...
)
|
Understand which Lean healthcare tools are currently being used to review processes and find the results of implementing such tools highlighted in the literature. |
Integrative literature review, covering from 2015 to 2019. The search strategy included the descriptors “Quality Management” and “Process Assessment (Health Care)”, as well as their synonyms in Portuguese and Spanish. All of them were associated with the keyword “Lean Healthcare” in the title or abstract. 240 articles were identified, and 123 duplicates were removed, and 100 were chosen which, after reading the full text, resulted in a sample of 33 articles. |
The main results evidenced with Lean contributions were:
- Time reduction: reduction of patient length of stay by 2.6%, reduction of length of admission from 20.6% to 17.8%, reduction of treatment time from 187 to 60 days, reduction of total operative time from 714 to 607 minutes, reduction in patient turnover time from 41 to 32 minutes, reduction in time between incision and application of surgical dressing from 81.5 to 71 minutes;
- Cost reduction: increase of US$ 1.31 in medical prescriptions/minute and US$ 3.27 in hospital costs/minute, reduction in the number of incidents due to billing errors, non-insurance coverage and incorrect information by 99.6%, 75.0% reduction in overtime;
- Workload reduction: team workload reduction by 70 minutes with a reversal of the time allocated for service by 9 minutes, reduction of distance traveled by automated infusion professionals by 14.6%, reduction of automated infusion tasks by 26 minutes per day;
- Patient response time: increase in response time to patient care from 50.9% to 60.4%, increase in punctuality of care from 76.1% to 81.9%, increase in discharge prescriptions by 10 am from 15.6% to 47.1%, increase in effective patient discharge by 12 pm from 10.5% to 20.6%, reduction in time between request and catheter insertion from 3.74 to 1.89 days. |
Using the main Lean tools has helped to improve processes in health services. However, although it is known that the Lean philosophy offers methods for applying and analyzing its results, it is important to highlight the importance of researchers properly designing their studies, with a sample size that supports scientific proof and the replicability of their applications. |
(1818 Ma H, Cao J, Li M. Application of PDCA Process Management in Day Operation Ward and the Influence of Nursing Quality and Safety. Comput Math Methods Med. 2022;2022:8169963. https://doi.org/10.1155/2022/8169963
https://doi.org/10.1155/2022/8169963...
)
|
Assess the application of process management using the PDCA tool (plan, do, check and act) in the daytime operation ward and its influence on nursing quality and safety. |
Comparative study, between March 2019 and March 2020, with a routine management model, and between March 2020 and March 2021, with the application of PDCA, conducted at a science and technology university hospital in Huazhong, Wuhan, China, including a sample of 907 patients. Nursing quality was observed in both groups based on the dimensions: nursing safety, specialist quality and nursing standards; individual quality control (assessments twice a month); quality of nursing in a surgical center (SC) (assessment one day after the operation: equipment management; preparation of materials and cooperation between the team; incidence of adverse events and nursing errors; number of problems in medical record document management; patient satisfaction). |
The PDCA cycle application led to improvements in the following areas:
- Quality of nursing and nursing safety;
- Improving the quality of nursing in the operating room, instrument management, instrument preparation, cooperation between nurses and disinfection;
- Decreased occurrence of adverse events and nursing errors, incidence of nosocomial infection, iatrogenic injury, information verification error, equipment failure, violation of operating regulations, electrocardiogram monitoring error, infusion operation error and medication;
- Improvement in number of problems on the temperature sheet, medical order, assessment sheet, nursing record, among other nursing documents;
- Improvement in nursing communication, professional technology, nursing service attitude, nursing environment and education. |
In summary, process management using PDCA, in the case group, compared to the control group, reduced the incidence of adverse events, non-conformities related to process management and nursing routines, providing improvements in nurses’ communication and educational attitudes (P<0.05). |
(1919 Ying J, Wang H, Ye H, Du C, Mao L. The supervision and management mode of disinfection supply center improves the standardization of sterile goods management in clinical departments. Comput Math Methods Med. 2022;6916212. https://doi.org/10.1155/2022/6916212
https://doi.org/10.1155/2022/6916212...
)
|
Investigate how the disinfection center participates in sterilized item supervision and management in clinical departments. |
Case study carried out at the Zhejiang University School of Medicine, Hangzhou-China, between July 2018 and June 2019. The routine covering the relationship between the MSC and the clinical departments was mapped, identifying the most frequent problems. Based on this scenario diagnosis, a standardized sterile clinical article management was incorporated, such as quality control, applied quarterly. MSC professionals inspected the storage environment for sterile items in 65 clinical departments. Assessments were carried out through on-site visits and control meetings with the inclusion of continuous improvement to support standardized management. |
- The main problems encountered were in relation to sterile kits that were expired and not removed from the storage area and the number of packages inconsistent with records;
- There was the standardization of aseptic items that contributed to reducing lost packaging and reducing costs (from 1,190 to 70 yuan) caused by the loss of sterile packaging. |
By adopting a decentralized way of supervising and managing sterile materials, MSC provided targeted training and on-site guidance to correct existing problems. At the same time, it contributed to rational consumption associated with the loss of sterile packaging, reducing costs. |
Thumbnail
