Reducing door-to-needle times using Toyota's lean manufacturing principles and value stream analysis.

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.

journal_name

Stroke

journal_title

Stroke

authors

Ford AL,Williams JA,Spencer M,McCammon C,Khoury N,Sampson TR,Panagos P,Lee JM

doi

10.1161/STROKEAHA.112.670687

subject

Has Abstract

pub_date

2012-12-01 00:00:00

pages

3395-8

issue

12

eissn

0039-2499

issn

1524-4628

pii

STROKEAHA.112.670687

journal_volume

43

pub_type

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