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Application of Lean principles to improve early cardiac care in the emergency department

Published online by Cambridge University Press:  11 May 2015

Zoë Piggott ,
Erin Weldon ,
Trevor Strome  and
Alecs Chochinov
Zoë Piggott*
Affiliation:
Royal College Emergency Medicine Residency Program, University of Manitoba
Erin Weldon
Affiliation:
Department of Emergency Medicine, University of Manitoba
Trevor Strome
Affiliation:
Department of Emergency Medicine, University of Manitoba Emergency Program, Winnipeg Regional Health Authority, Winnipeg, MB
Alecs Chochinov
Affiliation:
Department of Emergency Medicine, University of Manitoba Emergency Program, Winnipeg Regional Health Authority, Winnipeg, MB
*
Emergency Department, A1119, St. Boniface Hospital, 409 Tache Avenue, Winnipeg, MB R2H 2A6; zoepiggott@gmail.com

Abstract

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Objective:

To achieve our goal of excellent emergency cardiac care, our institution embarked on a Lean process improvement initiative. We sought to examine and quantify the outcome of this project on the care of suspected acute coronary syndrome (ACS) patients in our emergency department (ED).

Methods:

Front-line ED staff participated in several rapid improvement events, using Lean principles and techniques such as waste elimination, supply chain streamlining, and standard work to increase the value of the early care provided to patients with suspected ACS. A chart review was also conducted. To evaluate our success, proportions of care milestones (first electrocardiogram [ECG], ECG interpretation, physician assessment, and acetylsalicylic acid [ASA] administration) meeting target times were chosen as outcome metrics in this before-and-after study.

Results:

The proportion of cases with 12-lead ECGs completed within 10 minutes of patient triage increased by 37.4% (p < 0.0001). The proportion of cases with physician assessment initiated within 60 minutes increased by 12.1% (p = 0.0251). Times to ECG, physician assessment, and ASA administration also continued to improve significantly over time (p values < 0.0001). Post-Lean, the median time from ECG performance to physician interpretation was 3 minutes. All of these improvements were achieved using existing staff and resources.

Conclusions:

The application of Lean principles can significantly improve attainment of early diagnostic and therapeutic milestones of emergency cardiac care in the ED.

Keywords

acute coronary syndromeLean principlesprocess improvementtime to acetylsalicylic acid administrationtime to electrocardiogramtime to physician assessment
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 13 , Issue 5 , September 2011 , pp. 325 - 332
Copyright
Copyright © Canadian Association of Emergency Physicians 2011

References

REFERENCES

1.Bradley, EH, Nallamothu, BK, Curtis, JP, et al. Summary of evidence regarding hospital strategies to reduce door-to-balloon times for patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Crit Pathw Cardiol 2007;6:91-7.CrossRefGoogle ScholarPubMed
2.Bradley, EH, Herrin, J, Wang, Y, et al. Strategies for reducing the door-to-balloon time in acute myocardial infarction. N Engl J Med 2006;355:2308-20, doi:10.1056/NEJMsa063117.CrossRefGoogle ScholarPubMed
3.Bradley, EH, Roumanis, SA, Radford, MJ, et al. Achieving door-to-balloon times that meet quality guidelines: how do successful hospitals do it? JAm Coll Cardiol 2005;46:1236-41, doi:10.1016/j.jacc.2005.07.009.CrossRefGoogle ScholarPubMed
4.Gross, BW, Dauterman, KW, Moran, MG, et al. An approach to shorten time to infarct artery patency in patients with ST-segment elevation myocardial infarction. Am JCardiol 2007; 99:1360-3, doi:10.1016/j.amjcard.2006.12.058.CrossRefGoogle ScholarPubMed
5.Huynh, T, O’Loughlin, J, Joseph, L, et al. Delays to reperfusion therapy in acute ST-segment elevation myocar-dial infarction: results from the AMI-QUEBEC Study. CMAJ 2006;175:1527-32, doi:10.1503/cmaj.060359.CrossRefGoogle Scholar
6.Sutter, R, Tiefenbrunn, AJ, Bach, RG, et al. Hospital performance with myocardial reperfusion therapy: are hospitals capable of meeting established guidelines? Crit Pathw Cardiol 2003;2:197-206.CrossRefGoogle ScholarPubMed
7.Christenson, J, Innes, G, McKnight, D, et al. Safety and efficiency of emergency department assessment of chest discomfort. CMAJ 2004;170:1803-7, doi:10.1503/cmaj. 1031315.Google Scholar
8.Aldarrab, A. Application of Lean Six Sigma for patients presenting with ST-elevation myocardial infarction: the Hamilton Health Sciences experience. Healthc Q 2006;9:56-61.CrossRefGoogle ScholarPubMed
9.Ben-Tovim, DI, Bassham, JE, Bennett, DM, et al. Redesigning the Flinders Medical Centre: clinical process redesign using “Lean thinking.” Med J Aust 2008;188(6 Suppl):S27-31.CrossRefGoogle ScholarPubMed
10.Dickson, EW, Singh, S, Cheung, DS, et al. Application of Lean manufacturing techniques in the emergency department. J Emerg Med 2009;37:177-82, doi:10.1016/ j.jemermed.2007.11.108.CrossRefGoogle ScholarPubMed
11.King, DL, Ben-Tovim, DI, Bassham, J. Redesigning emer-gencydepartment patient flows: application ofLean thinking to health care. Emerg Med Australas 2006;18:391-7, doi:10.1111/j.1742-6723.2006.00872.x.CrossRefGoogle ScholarPubMed
12.Ng, D, Vail, G, Thomas, S, et al. Applying the Lean principles of the Toyota Production System to reduce wait times in the emergency department. CJEM 2010;12:50-7.CrossRefGoogle ScholarPubMed
13.Going Lean in health care. IHI Innovation Series White paper. Cambridge, MA: Institute for Healthcare Improvement; 2005. Available at: http://www.IHI.org (accessed October 16, 2008).Google Scholar
14.Ohno, T. Toyota Production System: beyond large-scale production, 1st ed. Portland (OR): Productivity Press; 1988.Google Scholar
15.Porter, ME, Teisberg, EO. Redefining competition in health care. Harv Bus Rev 2004;82:64-76.Google ScholarPubMed
16.Rother, M, Shook, J. Learning to see. Brookline (MA): The Lean Enterprise Institute; 1998.Google Scholar
17.Walley, P. Designing the accident and emergency system: lessons from manufacturing. J Emerg Med 2003;20:126-30, doi:10.1136/emj.20.2.126.CrossRefGoogle ScholarPubMed
18.Jones, C, Medlen, N, Merlo, C, et al. The lean enterprise. BT TechnolJ 1999;17:15-22, doi:10.1023/A:1009634706576.CrossRefGoogle Scholar
19.Hauswald, M. Triage: better tools but the wrong problem. Acad Emerg Med 2005;12:533-5, doi:10.1111/j.1553-2712.2005.tb00896.x.CrossRefGoogle ScholarPubMed
20.Anderson, JL, Adams, CD, Antman, EM, et al. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction: a report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines. Circulation 2007;116:e148-304, doi:10.1161/ CIRCULATIONAHA.107.737312.Google Scholar
21.Stat-It Survey (2008). St. Boniface Hospital, Winnipeg, MB.Google Scholar
22.Hewitt survey, 2007. St. Boniface Hospital, Winnipeg, MB.Google Scholar